IN THE CASE OF: BOARD DATE: 25 March 2021 DOCKET NUMBER: AR20200006099 APPLICANT REQUESTS: The applicant, the spouse of a Former Service Member (FSM), requests correction of the FSM's record to show he was medically retired in the rank/grade of staff sergeant (SSG)/E-6. APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: .DD Form 149 (Application for Correction of Military Record) .DD Form 293 (Application for the Review of Discharge from the Armed Forces ofthe United States) .Applicant letter .Marriage certificate, dated 16 September 1995 .DD Forms 214 (Certificate of Release or Discharge from Active Duty), dated16 October 2008 and 28 May 2011 .Veterans Affairs (VA) Form 21-0958 (Notice of Disagreement), dated 21 May 2014 .DA Form 2823 (Sworn Statement), dated 26 June 2014 .DA Form 2173 (Statement of Medical Examination and Duty Status), dated 10 July 2014 .Memorandum, Subject: Line of Duty (LOD) Determination for the applicant, dated 28 July 2014 .Memorandum, Subject: Notification of Separation Proceedings under ArmyRegulation (AR) 135-178 (Enlisted Administrative Separations), chapter 13,dated 25 September 2014 .VA Form 21-4138 (Statement in Support of Claim), dated 9 November 2014 .National Guard Bureau (NGB) Form 22 (Report of Separation and Record ofService), dated 13 March 2015 .VA adjudication, dated 16 March 2017 .VA letter number 1, dated 22 March 2017 .NGB Form 23B (Army National Guard (ARNG) Retirement Points HistoryStatement) .FSM fax to Disabled American Vets .Robert Wood Johnson Hospital radiology reports .Medical records .Lourdes Medical Center medical records .New Jersey police crash investigation report .Medical examiner report .Toxicology report .VA letter number 2, dated 29 March 2019 .Death certificate, dated 14 July 2019 FACTS: 1.The applicant states: a.The FSM was diagnosed with Post-Traumatic Stress Disorder (PTSD) in the LODafter an investigation according to AR 600-8-4 (LOD Policy, Procedures, and Investigations), paragraph 1-7(b). Instead of the FSM's commander speaking to him about why he did not come to drill, they just discharged him. The FSM should have been medically evaluated and medically discharged with his right to his pension and TRICARE. b.The FSM was suffering from PTSD, Traumatic Brain Injury (TBI), and alcoholismdue to his deployment in 2007-2008. His High Mobility Multipurpose Wheeled Vehicle (HMMWV) was shot by an incoming missile and he was thrown from the vehicle and lost his helmet as he was thrown up against a T wall in Kandahar. He should have been medically released and given a 15-year letter so he would have been eligible for his pension and TRICARE. Instead he was discharged with no benefits. He went to the VA and was rated 100 percent disabled. 2.A review of the FSM's official records shows the following: a.On 27 February 2007, having had prior enlisted service in the ARNG in MilitaryOccupational Specialty (MOS) 11B (infantryman), the FSM enlisted in the New York ARNG (NYARNG) in MOS 11B, in the rank/grade of sergeant (SGT)/E-5. b.On 9 October 2007, Orders Number 282-032, issued by the Office of the AdjutantGeneral, ordered the FSM to active duty in support of Operation Enduring Freedom for a period of 389 days. c.On 16 October 2008, the FSM was released from active duty and returned to hisNYARNG unit. d.The FSM's records are void of orders promoting him to the rank of SSG,however, it contains a DA Form 2166-8 (Noncommissioned Officer Evaluation Report) showing the FSM was promoted to the rank of SSG on 3 February 2009. e.On 26 March 2010, Orders Number A-03-009401, issued by the U.S. ArmyHuman Resources Command, St. Louis, MO, ordered the FSM to active duty for operational support with duty at Fort Dix, NJ for a period of 365 days in support of Operation Enduring Freedom. f.On 28 May 2011, the FSM was released from active duty and returned to hisNYARNG unit. g.On 12 January 2014, the FSM extended his 27 February 2007 enlistment by one-year, changing his Expiration Term of Service (ETS) from 13 March 2014 to 13 March 2015. h.On 2 December 2014, Orders Number 336-1021, issued by the Joint ForceHeadquarters (JFHQ), reduced the FSM from SSG to SGT for administrative reasons, under the provisions of AR 600-8-19 (Enlisted Promotions and Reductions), effective 2 December 2014. i.On 13 March 2015, the FSM was honorably discharged from the ARNG. Hecompleted 8 years and 17 days of net service with 8 years, 9 months, and 1 day of prior Reserve Component service, and 2 months and 29 days of prior active service. j.On 17 March 2015, Orders Number 076-999, issued by the JFHQ, honorablydischarged the FSM from the ARNG by reason of ETS, effective 13 March 2015. k.The FSM's records contain a NGB Form 23B showing the applicant completed 15 years of creditable service for retired pay. l.The FSM's records are void of a separation packet indicating he was separatedfrom the ARNG for unsatisfactory participation. Likewise, his record is void of any LOD documents. 3.The applicant provides: a.Self-authored letter that states: (1)She was writing this letter after the FSM passed in July 2019. After he died,she discovered paper work that disclosed incidents and details that she did not know. She is the wife of the FSM. They have been married for 24 years, and together for 28 years. The love of her life and her best friend. She misses him dearly. In July 1990, she and the FSM started dating and he was in the ARNG out of Greenfield Massachusetts. He enjoyed what he did, so much that he traveled over 2 hours each way for his monthly drills. They lived in upstate NY. He was always the life of a party and made everyone laugh. He truly was the man of her whole world. He would do anything for anyone, he even helped her raise her niece and nephew. As time went on, the FSM took a break from the Army so that they could start a life together and get married. They bought property and he started a little business. (2)In 2007, the FSM enlisted back into the Army to serve after 9/11. Eventhough they both did not agree to this, it was what he wanted. He told her that he only signed for a year and had missed being in. He was on a reserve list for deployment to Afghanistan, 2007-2008. He was told he was being deployed 10 days prior to his unit leaving. He called when he could and told her what he could, which was understandable, but scary for her. Upon returning after this deployment the FSM was not the same man. The first night he slept home he would sleep holding his hands like they were holding his rifle. He often had bad nightmares. One with his arms flying all over, striking her once. (3)The FSM asked her to drive every time they had to go anywhere. The onetime he did drive, he was driving on the wrong side of the road or he would drive and somehow forget where he was or where he was going. Another time they were driving, they had a large dump truck behind them. This truck made a loud sound as if the trucks back door had slammed shut. The FSM asked her to pull over and had issues breathing. He had her very worried and scared. He became quiet and conservative. He did not want to go out for dinner or shopping with her. When he did try to go out to eat, it seemed he needed to be seated facing the door of the restaurant. He hated to go anywhere there would be a crowd. While he was deployed, his unit went through some challenging situations, such as fire fights, Improvised Explosive Devices (IED) exploding, missiles and grenades being shot at the unit. Living conditions did not sound good. (4)On 21 June 2008 their HMMWV hit an IED in Kandahar killing four U.S.Soldiers. Hurting others that they were with as they were under a fire fight. The FSM being one of the injured. The reason she knows this happened is because they had taken a few support group classes together and this was his story he shared in a group session. The FSM had fallen in a hole made by the IED while carrying Lieutenant Colonel W- to a helicopter. The FSM was taken to the Kandahar Hospital for broken ribs and ankle. Not shared in group. She found this out after he had passed away. She found the x-rays with his military paper work he had in a box in his closet. (5)The FSM often went to support groups by himself and the Philadelphia VAbecause of the pain he was in. His pain was bad and he would drink. He told her he was sorry but it seemed to be the only thing that was helping. He started to forget things and isolate himself. At times he was not himself at all. He started to act out in strange behavior ways. Treating her and family members like they were the enemies. Many times the police had to come and talk him down and sometimes take him to the hospital to be evaluated. He mentioned to the local police that he did not want to live like he was anymore. (6)In 2012, while living in NJ where the FSM was working at Fort Dix, NJ, shehad to have a double mastectomy. While he did bring her to the hospital and stood right by her side. She had been in recovery over 4 hours and the FSM happened to leave the hospital. When it was time for her to be discharged, the FSM was nowhere to be found. He had left, and had not been able to find his way back to the hospital. After she had made several calls to his cell phone. He was in tears. He had not remembered where he was or how to get back to her. (7)The FSM tried so hard to go back in time to be himself again. In January, heeven booked them a Hawaiian birthday cruise for her 50th and his 47th birthday. Their room had been set up beautifully with a birthday cake, ribbons and balloons. The first night, one balloon popped. The FSM went crazy thinking it was a gunshot he heard. She tried to calm him without luck. He did not seem like himself at all. He turned to a bottle of alcohol. Eventually he stopped going out anywhere as a family. Vacations, even hunting. He could not fly anymore. When he did drive, he would take days to get home due to his drinking. He would stay in his jeep until he was able to get home or just rent a hotel. Sometimes she would find him in the hospital. (8)The FSM stopped going to drill and was never asked why. His commanderwrote a letter asking for him to be discharged and demoted. The FSM was so upset because he loved the military. He believes he should have gone to the Medical Hold Command where he would have been medically discharged and given a 15-year letter so that he would be able to collect his pension and would have been eligible for TRICARE. Instead, he was demoted and given an honorable discharge with 17 years [sic] of service. (9)She also discovered a completed LOD form and letter for PTSD from theNGB. When the FSM was discharged he could not work and applied for VA assistance and was given Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and was declared 100 percent disabled. She truly believes if he was medically discharged from New York, he might have received better mental health care and assistance with TRICARE than he did with CHAMPVA. He fought for his country and came back a different man. She along with many other spouses lost her husband/best friend to the war. (10)The FSM cannot be helped now but he did not deserve to be demoted anddischarged. She would like to see him get his rank back as well as a medical discharge, 15-year letter and TRICARE. She tried doing this with the Inspector General in NewYork but she was told they would only do this if the Army Board for Correction of MilitaryRecords ruled in the FSM's favor. She believes if he had the benefits of a medical retirement, he would have had better medical coverage, he would have had his pension and may be alive today. b.Marriage certificate showing the applicant and FSM were married on16 September 1995. c.VA Form 21-0958 showing the FSM had issues of disagreement with the VApertaining to employability, receiving supplemental security income, TBI, alcohol dependence, he had not worked in three years, he had no license to drive, going to jail for driving on a suspended license, tinnitus, PTSD, substance abuse, ankle injury, hearing loss, suicidal tendencies, kicked out of the Army, and a possible jail sentence of 18 months. d.DA Form 2823 showing the FSM authorized release of all medical documentsrelative to his medical care to the Joint Forces Headquarters, NYARNG, LOD. e.DA Form 2173 showing the FSM had a LOD completed at the Pennsylvania VAMedical Center for PTSD that developed during his deployment to Afghanistan 2007-2008, and was determined to be in the LOD. f.Memorandum, LOD Determination that states the Department of the Army HumanResources Command has delegated the authority to the NGB to act as the final approving authority for LOD investigations, to include members in a Federalized status or attending an active Army service school. Enclosed is a DA Form 2173 on the FSM for PTSD that occurred during Operation Enduring Freedom is approved "In LOD." g.Memorandum, Subject: Notification of Separation Proceedings Under AR 135-178, chapter 13 wherein the FSM was informed by his commander that he was initiating action to discharge the FSM from the ARNG for failing to attend annual training in 2014. The FSM's commander was recommending a General discharge characterization of service. h.VA Form 21-4138 wherein the FSM provided a statement to the VA pertaining toinfrequent headaches, light and sound triggers, tinnitus, use of alcohol and oxycodone. i.VA adjudication showing the FSM had service connected disabilities for PTSD,TBI, fractures of the right 7th rib, headaches, left ankle condition, and carpal tunnel syndrome. j.VA letter number 1 authored by a VA Staff Psychologist treating the FSM thatstates: (1)She has been providing the FSM psychotherapeutic treatment since22 August 2014 at the VA outpatient clinic at Marshal Hall, Fort Dix, and currently at the Victor J. Saracini outpatient clinic in Horsham, PA. The FSM also receives psychiatric medication management by Dr. K- at the addiction recovery unit at the VA Medical Center in Philadelphia, Pa. His current diagnoses include PTSD, depression, and alcohol dependence. (2)The FSM attends sessions as scheduled on a weekly basis. He is engagedand verbal in the sessions. He is committed to engaging in psychotherapeutic treatment. He is currently actively involved in prolonged exposure treatment focusing on his PTSD symptoms and improving his quality of life. k.FSM fax to the Disabled American Vets wherein he was adding additionalpsychiatric treatment following an elevated blood alcohol level and suicidal ideations. l.Robert Wood Johnson University Hospital radiology reports showing the FSM hada minimally displaced fracture of the right 7th rib. m.Medical records with emphasis on alcohol poisoning, elevated liver functions,PTSD history and alcohol dependence. n.Lourdes Medical Center records showing the FSM was diagnosed withdepressive disorder and alcohol dependence. o.NJ police crash investigation report showing the FSM was involved in a singlevehicle crash in which the FSM was pronounced dead at the scene. p.Medical examiners report showing the FSM had postmortem toxicology indicatingrecent use of alcohol with elevated postmortem blood levels. q.Toxicology report showing the FSM had an elevated blood alcohol level. r.VA letter number 2 authored by a VA addictions therapist that states the FSMattended his appointment with her in the addictions recovery unit at the Corporal Michael Crescenz VA Medical Center beginning on 29 March 2019 where they completed his addiction treatment interview and his treatment plan. He began group therapy sessions on 2 April 2019. The first part of the program meets twice a week for 4 weeks for standard outpatient treatment and then once a week for 5 months for aftercare. He will provide urine drug screens weekly throughout the duration of the program. The FSM appears motivated to work on his recovery. s.Death certificate showing the FSM died on 12 July 2019 as a result of a multipleinjuries sustained in a vehicular collision and the informant was the applicant. MEDICAL REVIEW: 1.The Army Review Boards Agency (ARBA) Medical Advisor was asked to review thiscase. Documentation reviewed included the applicant’s ABCMR application andaccompanying documentation, the military electronic medical record (AHLTA), the VAelectronic medical record (JLV), the electronic Physical Evaluation Board (ePEB), theMedical Electronic Data Care History and Readiness Tracking (MEDCHART)application, and the Interactive Personnel Electronic Records Management System(iPERMS). The ARBA Medical Advisor made the following findings andrecommendations: a.The applicant is now deceased. His widow has applied to the ABCMR requestinga medical retirement and for his rank be restored to Staff Sergeant (E6). She states: “He was diagnosed with PTSD in the line of duty after an investigation according to AR 600-8-4, para 1-7(b). Instead of his Commander speaking to him about why he did not come to drill, they just discharged him. My husband should have been medically evaluated and medically discharged with his right to his pension and Tricare. My husband was seeking help for his mental issues through the VA since he was discharged but I believe the demons were too much for him and he did not want to live anymore.” b.Evidence supports the approval of both requests. c.The Record of Proceedings outlines the applicant’s military service and thecircumstances of the case. The applicant’s National Guard Report of Separation and Record of Service (NGB Form 22) for the period of service under consideration shows he entered the Army National Guard on 27 February 2007 and was honorably discharged from the New York Army National Guard (NYARNG) on 13 March 2015 under the separation authority provided by chapter 6 of NGR 635-200, Enlisted Personnel Management. His discharge orders published by the NYARNG show was discharge at the expiration of his term of service. His DD 214 shows the former Infantryman served in Afghanistan from 22 December 2007 thru 23 September 2008. d.Review of his medical documents in MEDCHART shows he was placed on a dutylimiting permanent profile with an S3 for PTSD and “Mood Disorder” on 11 July 2014. The provider wrote in the comments section “SM is not to deploy to an austere environment. Limitations due to behavioral health concerns as per VA Psychologist and VA Psychiatrist.” The profile referred the applicant to a medical evaluation board. This is the first step in and should have initiated IDES processing of the applicant. e.A Line of Duty Determination approval memorandum from the National GuardBureau dated 28 July 2014 shows that his PTSD was an injury sustained in the line of duty to his country. f.A VA rating decision dated 19 May 2014 shows the Veteran had been determinedto be 50% disabled due to his PTSD. g.It is unknown why the applicant was not processed into the IDES as required bymultiple Army regulations. h.Paragraph 7-1 of AR 40-400, Patient Administration, states in part: “If the Soldierdoes not meet retention standards, an MEB is mandatory and will be initiated by the physical evaluation board liaison officer (PEBLO).” Note there is no mention of component or duty status. Paragraph 7-5b(5) is more direct for this case, stating that one of the situations which requires MEB consideration is “an RC member not on AD who requires evaluation because of a condition that may render him or her unfit for further duty.” i.Paragraph 3-2 of AR 635-40, Physical Evaluation for Retention, Retirement, orSeparation (20 March 2012), identifies the error made by his command: “When a commanding officer believes that a member of his command is unfit to perform the duties of his office, grade, rank, or rating because of physical or mental disability, he will refer the member for examination to the medical treatment facility which provides primary medical care to his command.” j.In a 25 September 2014 memorandum, the applicant’s company commanderinformed him that he was initiating his discharge “for continuous unexcused absences without leave (AWOL). The reason for my proposed action is a result in your failure to attend Annual Training 2014.” k.Orders published by the NYARNG on 2 December 2014 show the applicant’srank was reduced form staff sergeant (E6) to sergeant (E5) on the date of the orders. 2.In accordance with the Liberal Consideration guidance, it is the opinion of the ARBAmedical advisor that the applicant’s PTSD was a mitigating behavioral health condition.As there is an association between PTSD and avoidant behaviors, there is a nexusbetween the applicant’s mental health condition and his multiple incidents of AWOL. Itis therefore recommended that his rank be restored to Staff Sergeant. 3.The applicant was inappropriately administratively discharged when he should havebeen referred to the DES for at least one duty related condition (PTSD) which failed themedical retention standards of chapter 3, AR 40-501, Standards of Medical Fitness. It is therefore the opinion of the ARBA a long overdue referral of his case to the DES is clearly warranted. 4.In the event he is permanently retired for physical disability, it is the opinion of theARBA medical advisor that: a.His widow receive all retirement pay from 13 March 2015, the date of hisinappropriate discharge, thru 12 July 2019, his date of death. Furthermore, she should receive if she elects, all applicable Survivor Benefit Plan (SBP) payments from 12 July 2019 and going forward. She should be advised that if receipt of SBP payments is elected, SBP premiums effective the date of his discharge through his date of death must be recouped. b.His widow be refunded, to the extent it can be verified, all out of pocket medicalcare and health insurance monies paid by him or her for the family and their dependents between the date of his discharge and the date of her enrollment in TRICARE, if elected, or the date of his retirement for physical disability if TRICARE is not desired. Had the applicant been appropriately retired for physical disability, both he and his family would have been TRICARE eligible and so unlikely to have incurred few, if any, of these expenses. BOARD DISCUSSION: 1.After reviewing the application, all supporting documents, and the evidence foundwithin the military record, the Board found that relief was warranted. The applicant’scontentions, the FSM’s military record, a medical review, and regulatory guidance werecarefully considered. Evidence of record shows the FSM received an approved LOD fora PTSD diagnosis, which occurred during a period of active duty. The Board concurredwith a portion of the medical reviewer’s finding that the FSM should have been enteredinto the IDES before he was separated. The Board agreed the VA’s determination thathe was rated at 50% disabled for PTSD is persuasive evidence that he would havereceived that rating for PTSD by a properly constituted PEB. Therefore, the Boarddetermined the FSM should be placed on the PDRL with a 50% disability rating effectivethe date of his discharge. In addition, the applicant’s record shows he received aCombat Infantryman badge, therefore, the Board determined his disability should becombat related, and caused by an instrumentality of war. 2.Although liberal consideration is mentioned in the medical review, the Boardunderstands liberal consideration is applied to applicants seeking dischargecharacterization relief, including change of narrative reasons or reenlistment codes. Inthis case, the FSM’s record shows he was discharged with an Honorablecharacterization at the rank of SGT; therefore, liberal consideration is not a factor.However, the Board agreed that since his PTSD diagnosis was established before theadministrative demotion from SSG to SGT that the FSM’s rank should be restored. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 :XXX :XXX :XXX GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING : : : DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: The Board determined the evidence presented is sufficient to warrant a recommendation for relief. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by: a.revoking Orders 336-1121, issued by JFHQ, Latham, NY on 2 December 2014that administratively reduced the FSM in rank; b.revoking Orders 076-999, issued by JFHQ, Latham, NY on 17 March 2015 thatdischarged him from the NYARNG;c.issuing the FSM orders showing he was placed on the PDRL effective 13 March2015, at the rank of SSG, with a 50% disability rating; andd.allowing the applicant to complete a request for retired pay in behalf of the FSM,which will initiate appropriate retired pay and Survivor Benefit Program actions. X CHAIRPERSON I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case. REFERENCES: 1.Army Regulation 135-180 (Qualifying Service for Retired Pay Non-Regular Service),states in paragraph 2-1, to be eligible for retired pay, an individual need not have amilitary status at the time of application, but must have 15 years of qualifying service,and less than 20, computed under Title 10, United States Code, section 12732, if theindividual is to be separated because the Soldier has been determined unfit forcontinued Selected Reserve service. 2.National Guard Regulation 680-2 (Automated Retirement Points AccountManagement): a.Sets responsibilities and procedures to establish and maintain retirement records,establish the anniversary year, determine service requirements to qualify for retirement for non-regular service, prepare and issue notifications of eligibility for retired pay for non-regular service. b.Paragraph 2-4 states Soldiers must earn a minimum of 50 retirement points,regardless of source, in each full anniversary year to have that year creditable towards verification of the total years of qualifying service for non-regular retired pay. c.Paragraph 3-2 states ARNG Soldiers in an active status with at least 15, andfewer than 20, years of qualifying service who are disqualified from continued service due to physical disability and meet all other eligibility criteria may be retired. Soldiers will be discharged from the ARNG and transferred to the U.S. Army Reserve for assignment to the Retired Reserve before the 15-year Notification of Eligibility can be generated and issued. 3.Army Regulation 600-8-19 (Enlisted Promotions and Reductions) states: a.Administrative reductions are announced in orders for SGT and above. These willbe filed in the individual Soldier’s Army Military Human Resources Record. b.Paragraph 10-17; reductions under this paragraph are discretionary and whollyapart from discharge proceedings under AR 135-178. A soldier may be reduced one grade for unsatisfactory participation. The commander reducing the Soldier will inform the Soldier in person or by certified mail of the action contemplated and reasons. The Soldier may submit any pertinent matters in rebuttal. c.There is no provision in this regulation pertaining to rank restoration afterreduction for unsatisfactory participation. 4. Army Regulation 135-178 (Enlisted Administrative Separations) states a Soldier is subject to discharge for unsatisfactory participation when it is determined that the Soldier is unqualified for further military service because the Soldier is: . an unsatisfactory participant and; . attempts to have the Soldier respond or comply with orders or correspondence have resulted in the Soldier’s refusal to comply with orders or correspondence; or . a notice sent by certified mail was refused, unclaimed, or otherwise undeliverable 5. Army Regulation 40-501 (Standards of Fitness) governs medical fitness standards for retention and separation, including retirement. Chapter 3 of the regulation gives the various medical conditions and physical defects which may render a Soldier unfit for further military service. 6. The Fifth Revision of DSM-5 was released in May 2013. This updated edition included 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) . Recurrent, involuntary, and intrusive memories . Traumatic nightmares . Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness . Intense or prolonged distress after exposure to traumatic reminders . 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) . Trauma-related thoughts or feelings . 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) . Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs) . Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous") . Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences . Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame) . Markedly diminished interest in (pre-traumatic) significant activities . Feeling alienated from others (e.g., detachment or estrangement) . 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) . irritable or aggressive behavior . self-destructive or reckless behavior . hypervigilance . exaggerated startle response . problems in concentration . 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. 7. On 25 August 2017, the Office of the Under Secretary of Defense for Personnel and Readiness issued clarifying guidance for the Secretary of Defense Directive to Discharge Review Boards 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; TBI; sexual assault; and 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 to 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. //NOTHING FOLLOWS//