ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS IN THE CASE OF: BOARD DATE: 29 August 2019 DOCKET NUMBER: AR20180016785 APPLICANT REQUESTS: upgrade of his general discharge under honorable conditions. APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * two self-authored letters * self-authored memorandum for record * table of contents * DD Form 293 (Application for the Review of Discharge from the Armed Forces of the United States) * Army Discharge Review Board (ADRB) denial * 16 DA Forms 67-9 (Officer Evaluation Report (OER)) * numerous awards, commendations, and training certificates * DD Form 214 (Certificate of Release or Discharge from Active Duty) * Laurel Ridge Treatment Center Psychiatric Evaluation and Initial Treatment Plan * Lauren Ridge Treatment Center Discharge Summary * 57 pages of service medical records * Department of Veterans Affairs (VA) records * Office of the Surgeon General (OTSG)/U.S. Army Medical Command (MEDCOM) Policy Memorandum 12-035, dated 10 April 2012 * excerpts from VA/Department of Defense (DOD) Clinical Practice Guideline for Management of Post-Traumatic Stress Disorder (PTSD) * multiple published articles regarding PTSD * U.S. Government Accountability Office (GAO) Report To Congressional Committees, DOD Health – Actions Needed to Ensure PTSD and Traumatic Brain Injury are Considered in Misconduct Separations, dated May 2017 * press release: DOD Releases Clarifying Guidance to Veterans Regarding Discharges and Military Records, dated 28 August 2017 FACTS: 1. The applicant states: a. His discharge should be upgraded to honorable because OTSG/MEDCOM Policy Memorandum 12-035, dated 10 April 2012, was not adhered to in that he was not given a comprehensive behavioral health interview for PTSD prior to his discharge. His undiagnosed PTSD resulted in marital discord and contributed to his misconduct. b. He feels it is important to notify the Board that as of 20 January 2018, he is considered totally and permanently disabled by the VA due to service-connected disabilities. As a totally and permanently disabled veteran, he should be afforded additional protections and rights which have been denied to him based on the characterization of his service, including commissary privileges and educational benefits for his spouse and dependents. c. As a permanently disabled veteran, he believes his current characterization of service does him and other veterans suffering from mental health conditions great harm, but thanks to the great care and concern of the VA healthcare system, he has been able to resume a productive and healthy life. d. In the June 2018 ADRB denial of his request for upgrade of his discharge, a presumption of regularity was stated as a reason for the denial of his claim. The burden of overcoming a presumption of regularity rests with the applicant and he feels he has submitted sufficient evidence to show the presumption of regularity should not be assumed based on his extensive behavioral health history and Army policy guidance (the above-referenced OTSG/MEDCOM policy memorandum) which was not adhered to. e. In this particular case, it must be assumed that a behavioral health referral should have occurred, as OTSG/MEDCOM Policy Memo 12-035 was in place at the time of the applicant’s misconduct and it stresses the stigma of behavioral health issues as one of the main reasons for a lack of diagnosis. Additionally, concern by parties believing a Soldier to be malingering for secondary gain in DOD and VA PTSD evaluations was shown to be very rare based on an internal review by the VA Office of the Inspector General in 2005. As a result, the VA relaxed its policies that required veterans to provide proof of specific combat-related traumatic stressors. f. The applicant did indeed have both traumatic stressors as a trauma anesthesiologist in Iraq and had a prior history of a major depressive disorder so severe that it interrupted his ability to care for patients after the war in 2009 while serving at Brooke Army medical Center. This major depressive disorder was labeled as atypical depression and not PTSD. In addition to the major depressive disorder he suffered, there is evidence to support he had severe discord with his wife ongoing difficulty readjusting back to his role in his family. All of these issues occurred in the summer of 2012, after his redeployment from Iraq in 2005. g. The OTSG/MEDCOM memorandum in question stated signs and symptoms of PTSD can manifest with social problems at home and/or in misconduct and such behavior should result in a behavioral health assessment referral for assessment of PTSD. This memorandum was addressed to Commanders, MEDCOM Regional Commands, but it is NOT a presumption of regularity to assume that each of the regional medical commanders would have been familiar with the guidance coming from the OTSG regarding the assessment and treatment of PTSD or that these commanders knew of the policy in this memorandum or that it was widely distributed.. h. The applicant’s extensive behavioral health records along with the OTSG/MEDCOM memorandum overcome any presumption of regularity which the ADRB alleged in his case. The reality is that his commanders did not follow the OTSG guidelines and chose the expedient path of using non-judicial punishment independent of the medical route, which is totally contradictory to the policy guidance. i. Interestingly enough, the stigma related to behavioral health did not exist when the applicant had his initial VA evaluation after his discharge. There was a process whereby the VA encouraged veterans to have dialogue regarding any behavioral health issues which occurred while they were in service. In the time between the applicant’s misconduct and his 20 January 2016 discharge, such a culture of encouraging diagnosis and treatment for PTSD did not exist at either Moncrief Army Community Hospital or at Womack Army Medical Center. j. He hopes to highlight certain factors to be considered by the Board under the context of the Office of the Under Secretary of Defense memorandum directive dated 25 August 2017 (providing clarifying guidance for Boards considering discharge modifications of Soldiers due to mental health conditions) as well as the U.S. GAO Report to Congressional Committees DOD Health Report: Actions Needed to Ensure PTSD and TBI are Considered in Misconduct Separations. The applicant suffered significant bipolar and PTSD conditions which went undiagnosed at the time of his separation on 20 January 2016, due to systemic failures of the Army to conduct mental health screenings and evaluation prior to the time of involuntary separation from the military for misconduct. The applicant’s undiagnosed mental health conditions directly contributed to his erratic personal behavior with his wife and the affair he confessed to having committed. k. The lack of diagnosis and treatment of his conditions should outweigh the current characterization of his service because of the following factors: * his bipolar disorder diagnosis was given to him at Laurel Ridge Treatment Facility while he was serving on active duty in February 2009 * his long history of DOD mental health care with medicines known to treat bipolar disorder, to include lamotrigine and lithium * the inability of mental health providers in the Army to provide a diagnosis of PTSD due to excessive Army regulations and burdens placed on mental health providers during his period of service from 200- through 2016 * his lack of consistent mental health care follow-up and treatment at Fort Jackson, SC, where he was not placed back on his medications which he left Fort Sam Houston, TX being prescribed * the failure of the Fort Bragg, NC Staff Judge Advocates to ensure he was properly screened for mental health disorders prior to his administrative separation from the Army * the VA’s diagnosis of his PTSD and bipolar 1 disorder within 6 months of his discharge, to include awarding him 30 percent disability for his bipolar 1 disorder * untreated bipolar 1 disorder is known to be associated with high risk and manic behavior often reflected in hypersexual behavior * evidence on his most recent psychiatric examination that he continues to have PTSD symptoms any may have previously met the full criteria for diagnosis of PTSD l. At the time of his separation, an individual from the U.S. Army Human Resources Command (HRC) requested that a mental health evaluation be conducted on the applicant, but the mental health providers at Womack Army Medical Center refused, quoting the National Defense Authorization Act for Fiscal Year 2010 where the law’s screening requirements only apply to certain service members facing administrative separation under other than honorable conditions. The law requires screening for those service members who have been deployed overseas in support of a contingency operation during the previous 24 months and have been diagnosed with PTSD or traumatic brain injury by one of five provider types: * physician * clinical psychologist * psychiatrist * licensed clinical social worker * psychiatric advanced practice registered nurse m. The 24 month requirement is totally arbitrary and not all of the services follow this requirement. The GAO-17-260 report indicates there are inconsistencies amongst the uniformed services with regard to screening for PTSD, which illustrates how arbitrary these recommendations are in reality and not based on any solid medical per reviewed literature. n. The U.S. Army’s refusal to address the applicant’s potential mental health issues is a causative factor for his misconduct. He was diagnosed with bipolar 1 disorder in February 2009 by an impartial civilian psychiatrist at Laurel Ridge Hospital who was not under any undue command pressure that would influence her clinical decisions. Once he was released from Laurel Ridge Treatment Center, he was treated by a psychiatrist at Brooke Army Medical Center (BAMC) with Lamotrigine, lithium, and Welbutrin, all drugs known to treat patients with bipolar disorder. He remained on these medication until June 2010, when he moved to Fort Jackson, SC, and was lost to follow up care. In late May 2012, he sought out treatment for anxiety and was seen by a psychiatrist at Moncrief Army Community Hospital, who chose only counseling for the applicant and did not place him on any of his previous medications. This poor continuity of care resulted in the applicant not receiving a proper diagnosis and medication. o. The applicant’s case clearly shows that not only was he not diagnosed with bipolar 1 or PTSD, but that stigmata of mental health conditions in the Army, the institutional resistance to diagnosis of mental health conditions, and potential undue command influence resulted in the applicant’s involuntary administrative separation without a single consideration of his extensive mental health history. Shortly after his discharge, the VA properly diagnosed him with bipolar 1 and PTSD, because they were unbiased and were not constrained by the Army regulations. 2. The applicant was appointed as a Reserve Commissioned Officer of the Army effective 7 May 1994. 3. He served as an anesthesiologist in Iraq from 7 November 2004 through 4 May 2005. 4. He provided a Laurel Ridge Treatment Center Discharge Summary, dated 17 April 2009, which states: a. The applicant was admitted to the Laurel Ridge Treatment Center on 17 February 2009 after being sent from the BAMC Emergency Room following an episode of suicidal ideation after a conflict with his superiors on the job and marital difficulties. He reported he had been kicked out of the family house a few days prior to this admission and was staying in a hotel room with significant suicidal ideation. He was treated with Lithium up to 450 milligrams per day to improve his pacing and paranoia and Risperdal to help with sleeping. b. His condition on discharge was very pleasant, cooperative, attentive. His mood was mildly depressed. There was very minimal anxiety. He denied any suicidal or homicidal ideation. His prognosis was fair as long as he complied with the treatment. He had a follow-up scheduled at BAMC for 26 February 2009. c. He was discharged on 25 February 2009 with diagnoses of bipolar I disorder, most recent episode depressed, severe with psychosis, in early remission, history of asthma, and problems with primary support, occupational. 5. Multiple Standard Forms 600 (Chronological Record of Medical Care), show he was seen as an outpatient at the BAMC, Community Mental Health Troop Medical Clinic and the BAMC Psychiatry Clinic on the following occasions with the following annotated notes: * 26 February 2009 post hospitalization with a comprehensive psychiatric interview being conducted and given a diagnosis of adjustment disorder with anxiety and depressed mood and to continue individual outpatient counseling; he was released with no duty limitations * 17 March 2009 for medication management with a diagnosis of adjustment disorder with anxiety and depressed mood * 24 April 2009 for medication management with a diagnosis of acute stress disorder 6. The applicant submitted OERs covering the following periods of service, which show: * 1 July 1998 through 30 June 1999, Outstanding Performance, Must Promote * 1 July 1999 through 30 June 2000, Outstanding Performance, Must Promote * 1 July 2000 through 30 June 2001, Outstanding Performance, Must Promote * 1 July 2001 through 23 June 2002, Outstanding Performance, Must Promote * 1 July 2003 through 30 June 2004, Outstanding Performance, Must Promote * 1 July 2004 through 5 November 2004, Outstanding Performance, Must Promote * 6 November 2005 through 1 July 2007, Outstanding Performance, Must Promote * 2 July 2006 through 1 July 2007, Outstanding Performance, Must Promote * 2 July 2007 through 1 July 2008, Outstanding Performance, Must Promote * 2 July 2008 through 1 July 2009, Outstanding Performance, Must Promote * 2 July 2009 through 1 July 2010, Outstanding Performance, Must Promote * 2 July 2010 through 24 February 2011, Outstanding Performance, Must Promote * 25 February 2011 through 24 February 2012, Outstanding Performance, Must Promote * 25 February 2012 through 24 February 2013, Outstanding Performance, Must Promote * 25 February 2013 through 24 February 2014, Outstanding Performance, Must Promote * 25 February 2014 through 21 May 2015, rated 1 out of 11 officers and Highly Qualified 7. On an unspecified date, the applicant’s battalion commander requested initiation of a General Officer Memorandum of Reprimand (GOMOR). She conducted a preliminary investigation under Rule for Courts-Martial 303, Uniform Code of Military Justice (UCMJ) into the applicant’s conduct and the investigation revealed the following: a. The applicant admitted to his former commander that he committed adultery in June 2012. b. He broke a window and entered his family’s residence while he was living apart from his spouse. During his time in the residence, he committed acts of physical and mental abuse against his wife, by threatening his wife and her guest and preventing her from calling 911 by breaking her cell phone. c. She recommended the initiation of a GOMOR against the applicant for his misconduct. 8. On 15 August 2014, his brigade commander likewise recommended the initiation of a GOMOR against the applicant. 9. On 4 September 2014, the Commander, Headquarters, Fort Bragg, NC, issued the applicant a GOMOR, which states: a. An investigation revealed he wrongfully had sexual intercourse with a woman who was not his spouse in June 2012, and admitted this to the former Commander, Moncrief Army Community Hospital. Additionally, he placed an ad on a dating website for married individuals called Ashley Madison, which uses the motto: “Life is short. Have an affair.” Furthermore, on 7 December 2013, he acted in a manner unbecoming an officer by committing acts of mental abuse against his wife, threatening her and her guest, breaking her phone, and preventing her from calling 911. b. His behavior demonstrated a complete lack of discipline and poor judgment that betrayed the special trust and confidence placed in him as a commissioned officer in the U.S. Army. Due to the applicant’s failure to maintain those high standards, the Commanding General had grave reservations about his suitability for continued service in the U.S. Army. c. The GOMOR was imposed as an administrative measure and not as nonjudicial punishment under Article 15 of the UCMJ. The applicant was advised the imposing authority intended to direct the filing of this GOMOR in the applicant’s Official Military Personnel File (OMPF), but the applicant had the right to submit matters in his behalf. 10. On 28 October 2014, the applicant acknowledged receipt of the GOMOR and that he read and understood it. There is no indication in the available records he elected to submit written matters of extenuation, mitigation, or rebuttal. On 3 December 2014, the GOMOR imposing authority directed the permanent placement of the GOMOR in the applicant’s OMPF after careful consideration of the recommendations of subordinate commanders, the circumstances of the misconduct, and all matters submitted by the applicant in his defense. 11. On 21 August 2015, the applicant voluntarily requested resignation from the Army under the Provisions of Army Regulation 600-8-24 (Officer Transfers and Discharges) chapter 4, in lieu of further elimination proceedings and requested consideration for an honorable characterization of service. He elected to waive any right to either appear before a board of officers or to submit matters in explanation, rebuttal, or defense concerning the allegations in his case. He acknowledged understanding he would be furnished an honorable or general discharge under honorable conditions. 12. A 17 September 2015 memorandum from HRC to the Deputy Assistant Secretary of the Army (Review Boards), enclosed the applicant’s request for resignation in lieu of elimination and stated the following: a. Elimination action of the applicant was initiated by the Commanding General, HRC, on 29 January 2015, for misconduct and moral or professional dereliction. b. The General Officer Show Cause Authority recommended the approval of the applicant’s resignation with a general, under honorable conditions characterization of service. 13. On 6 January 2016, the Department of the Army Ad Hoc Review Board reviewed the applicant’s tendered resignation in lieu of elimination and the Deputy Assistant Secretary of the Army (Review Boards) accepted his resignation with a general, under honorable conditions characterization of service. 14. His DD Form 214 shows he was discharged accordingly on 20 January 2016, after 17 years, 7 months, and 13 days of net active service this period due to unacceptable conduct in accordance with Army Regulation 600-8-24, after voluntary request for resignation in lieu of elimination. It shows among the decorations he was awarded or authorized are the Meritorious Service Medal (3rd Award), Army Commendation Medal, and the Army Achievement Medal. His service was characterized as general, under honorable conditions. 15. The applicant provided a VA document showing he has a combined disability rating of 100 percent for the following service-connected disabilities effective 21 January 2016: * bipolar disorder (also claimed as depression, PTSD, anxiety, and depressed mood, 30 percent * right knee degenerative arthritis, 10 percent * asthma, 30 percent * fibromyalgia, 40 percent * tinnitus, 10 percent * left upper extremity cubital tunnel syndrome (also claimed as ulnar nerve incomplete paralysis and cranial nerve condition), 10 percent * let shoulder osteoarthritis, 20 percent * sinusitis, 10 percent * right upper extremity cubital tunnel syndrome, 10 percent * left extremity sciatic nerve radiculopathy, 10 percent * varicose veins right lower leg, 10 percent * residuals status post left knee anterior cruciate ligament tear with instability, 10 percent * right knee degenerative arthritis, 10 percent * varicose veins left lower leg, 10 percent * intervertebral disc syndrome with spinal stenosis, 10 percent 16. The applicant applied to the ADRB on 1 March 2017, requesting an upgrade of his discharge to honorable and a change to the narrative reason for his discharge. The ADRB denied his request, having determined he was properly and equitably discharged. 17. On 16 August 2019, the Army Review Boards Agency (ARBA) medical advisor/clinical psychologist provided an advisory opinion which states: a. The applicant applied to the ADRB in March 2017 requesting an upgrade, noting an undiagnosed medical condition contributed to his misconduct. He reported having an in-service diagnosis of bipolar disorder in 2009, but his records were lost with a permanent change of station move and the unfitting condition was missed. He contended when he reengaged with behavioral health, he was misdiagnosed. He maintained he had an unfitting condition that the Army failed to diagnoses and treat and his command failed to act on it, which contributed to his misconduct. b. None of the applicant’s in-service diagnoses spanning from 2001 – 2015 include bipolar disorder. VA diagnoses include service-connected conditions, but not PTSD. His Compensation and Pension exam diagnosed him with a bipolar disorder rated at 50 percent disabling. There are four encounters listing PTSD in the description box; however, the record is void of a PTSD diagnosis. c. The applicant’s service records consistently noted excellent performance, absence of impairment, and only sporadic involvement with behavioral health. He did not have an unfitting conditions nor was he at a medical retention determination point. Irrespective, his misconduct would not be attributable to PTSD or bipolar disorder and his misconduct is not a natural progression or normal sequel of PTSD or bipolar disorder. d. The applicant asserts the OTSG/MEDCOM Policy Memorandum 12-035 dictates the Army was required to conduct a comprehensive behavioral health evaluation before his separation and had that transpired, he would have been found to have an unfitting condition that mitigated his misconduct. The applicant did not have an unfitting condition requiring a medical board nor did he have a behavioral health condition mitigating his misconduct. Additionally, this policy provides clinical guidance on the methods by which providers assess, diagnose and treat PTSD; it is not a separation policy. e. The OTSG/MEDCOM policy memoranda addressing separation, as they relate to behavioral health involvement, were considered. The applicant’s case would not fall under OTSG/MEDCOM Policy Memo 16-118, as he was not separated under misconduct, fraudulent entry, security reasons, or in lieu of trial by court-martial; he resigned in lieu of elimination. His case would also not fall under OTSG/MEDCOM Policy Memo 14-060 as he was not separated with an other than honorable conditions characterization of service. f. The Army medical advisory/clinical psychologist determined , based on a thorough review of all available records and related policies, a behavioral health evaluation was not required or mandated given the specifics of the applicant’s case. There is no evidence to indicate he had an unfitting condition in service that required a referral to a medical board or mitigated his misconduct. A copy of the complete medical advisory was provided to the Board for their review and consideration. 18. The applicant was provided a copy of the advisory opinion on 21 August 2019 and given an opportunity to submit comments, but he did not respond. BOARD DISCUSSION: After review of the application and all evidence, the Board determined relief is not warranted. The applicant’s contentions and the medical advisory opinion 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. He did not provide character witness statements or evidence of post-service achievements for the Board to consider. He was discharged after resigning his commission for unacceptable conduct and was provided an under honorable conditions (General) characterization of service. The Board agreed that the applicant's discharge characterization is warranted as he did not meet the standards of acceptable conduct and performance of duty for Army personnel. Furthermore, he had no diagnosis of PTSD during his period of service, and his deployment was well outside of the policy requirement to be within 24 months of the misconduct if he fell under the policy. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : : : GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING :X :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 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. REFERENCES: 1. 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; or sexual harassment. Boards are 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 misconduct that led to the discharge. 2. 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 on the basis of 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. 3. The National Defense Authorization Act for Fiscal Year 2010, section 512, mandated under regulation 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 during the previous 24 months, and who is diagnosed by a physician, clinical psychologist, or psychiatrist as experiencing PTSD or traumatic brain injury or who otherwise reasonably alleges, based on the service of the member while deployed, the influence of such a condition, receives a medical examination to evaluate a diagnosis of PTSD or traumatic brain injury. a. In a case involving PTSD, the medical examination shall be performed by a clinical psychologist or psychiatrist. In cases involving traumatic brain injury, the medical examination may be performed by a physician, clinical psychologist, psychiatrist, or other health care professional, as appropriate. b. The medical examination required by this subsection shall assess whether the effects of PTSD or traumatic brain injury 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. The medical examination and procedures required by this section do not apply to courts-martial or other proceedings conducted pursuant to the UCMJ. 4. Army Regulation 600-8-24 (Officer Transfers and Discharges) provides the basic authority for the transfer or discharge of Army officer personnel. a. Chapter 4 outlines the policies and procedures for the elimination of officers from the active army for substandard performance of duty, misconduct, moral or professional dereliction, and in the interest of national security. A discharge of honorable, general, or under other than honorable conditions may be granted. b. An officer identified for elimination may at any time during or prior to the final action in the elimination case, elect one of the following options (as appropriate): * submit a resignation in lieu of elimination * request discharge in lieu or elimination * apply for retirement in lieu of elimination if otherwise eligible 5. OTSG/MEDCOM Policy Memo 12-035, dated 10 April 2012, provides policy guidance on the assessment and treatment of PTSD. a. It provides guidelines to aid clinicians in the assessment, clinical decision- making, and treatment of PTSD and related conditions and is relevant for all healthcare professionals who are providing or directing treatment services to patients with PTSD at any VA or DOD healthcare setting. It directs clinicians to use the 2010 VA/DOD Clinical Practice Guideline for the management of PTSD in the assessment and treatment of patients presenting with PTSD. b. For a diagnosis of personality disorder as part of an administrative separation process, an evaluation for PTSD is required and OTSG approval is required. For a diagnosis of adjustment disorder as part of an administrative separation process for any Soldier who has ever been deployed to an imminent danger pay area, an evaluation for PTSD is required as well as OTSG approval is required. ABCMR Record of Proceedings (cont) AR20180016785 13 1