Posted on Aug 7, 2023
SGT Mortarman
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This is going to be a lengthy post so I'm going to break it down into sections consisting of history and all relevant details that lead up to the situation and questions I have regarding my understanding of the regulations/instructions involving this matter. For those who do know the answers to my questions, please reference where I can find the information for my own situational awareness.

*For the sake of this post I will not be providing the location of where I reside, or the names of the parties involved to keep things as anonymous as possible due to not knowing who actively uses this website

I was active duty in the Marine Corps from 2014-2022, requiring a waiver to enlist for reconstructive earlobe surgery (I enlisted in HS and had my ears gauged but the holes did not close up small enough for enlistment purposes). In 2021 I started a tour of recruiting duty, and it was the worst experience of my life. The station commander at my office is arguably the most egregious human being I've ever had the displeasure of meeting. Within the beginning months of my tour, I started dealing with really bad anxiety and depression primarily due to the maltreatment (details for this post are not necessary) I had to endure from my station commander on an almost daily basis. Moving forward to November 2021 I made the decision to start receiving behavioral health care at my local MTF where I was diagnosed with "Adjustment disorder with mixed anxiety and depressed mood F43.23" and "Unspecified problems related to employment Z56.9". The MTF put me on limited duty for six months and referred me to a two-week outpatient partial hospitalization program in December 2021 prior to starting my full-time care with them, where they concurred with the adjustment disorder diagnosis and started me on medication. In March 2022 I was given a relief for the good of service by the recruiting command and was in the process of being administratively separated for the adjustment disorder and was recommended for a general discharge by the district commander for "failure to adapt", with a general and specific basis of "convenience of the government/condition not a disability". The administrative separation process was subsequently terminated as the command received authorization to terminate my extension and I started terminal leave in June 2022 and in July 2022 I received an honorable discharge for completion of required active service with a RE-1A.

*Note - during this time I was found fit for duty but was not found suitable for continued service

While I was on terminal leave, I started the enlistment process with the Army National Guard in my neighboring state and was able to work it out with my recruiter to enlist the day following my EAS. I required no waivers for enlistment and was given 1s for all of my PULHES codes. In November 2022 I had conducted an IST to my resident state, and on January 1 of this year I started on FTNGD-OTD orders as an ADOS recruiter in the same town I was recruiting in the Marine Corps with some of the same high schools assigned to me.

After starting back on recruiting duty, I started dealing with reoccurring issues of anxiety and depression again and as a professional courtesy I informed my section chief I was going to start receiving behavioral health treatment again, and he informed the MedDet Director of Psychological Health (CIV) about my decision. The DPH came across as a very genuine dude after my first couple phone calls with him. He told me he'd be opening a case on me for time being while serving as my case manager, told me to go back to the MTF to get referrals to receive care from civilian providers, and said he'd close the case when everything is resolved. During that time my PCM and another physician at the MTF diagnosed me with generalized anxiety disorder and emotional impulsivity.

In May I had my first appointment with a civilian psychiatrist who "diagnosed" me with "mood disorder" and started me on a mood stabilizer that's commonly used to treat bipolar disorder, although he did not diagnose me with bipolar disorder, and explained that the "mood disorder" was more so an annotation for the medication and not an actual diagnosis. A couple weeks later I went to MedDet for a PHA and during the questionnaire portion of it I did not answer any of the behavioral health questions as I did not want anyone from there involved in my care and treatment. When I sat down with the DPH for his portion of the PHA he asked me about my care and treatment, and I said I did not want to disclose any of that information. He told me by regulation I was required to, so I complied, gave him the information he wanted, and signed a records release so he could obtain my records from my psychiatrist (I only had two appointments with him at this time). He told me that all I needed to do was provide a 90-day medication stability letter and I would be fine. The following week I was put on a temporary profile for "adjustment disorder" (which I was unaware of why at the time) and told I needed to come to MedDet to do a fit for duty evaluation with a behavioral health officer due to the medication I was prescribed during drill in June.

I spent about an hour and a half talking with the BHO during my eval and she subsequently told me I was not allowed to be on that medication at all in service due to it being on the DoD list of deployment limiting psychiatric medications, as it is technically classified as an anti-convulsant, and said that she had to initiate the MEB process. I asked her if I could just come off of the medication and start on one that was authorized for use in service, and she said no the process had to be initiated regardless because of the fact I was prescribed it.

That following week I was asked to come to MedDet for one of the other case managers to speak with me. She told me that based on the fit for duty evaluation notes this was not a line of duty issue, and I was going to be processed for a Non-Duty Related PEB. I asked several questions regarding this, including having a documented history of anxiety/depression due to my time on recruiting duty in the Marine Corps, and how prolonged periods of excessive levels of stress can have long lasting effects on behavioral health. She said that didn't matter because it wasn't due to anything that happened in the Army. I asked her to send me a copy of the fit for duty evaluation notes, which were documented on my SF Form 600 Chronological Record of Medical Care, and that is where I found that the DPH had diagnosed me with "Adjustment disorder with mixed anxiety and depressed mood F43.23", during my PHA, which was the same diagnosis and ICD-10 code I received in the Marine Corps, and I found a lot of discrepancies and inaccuracies on the fit for duty evaluation notes, and concluded the notes saying I was not for duty and PEB. I asked about seeing the BHO to get the information fixed/corrected and I was told I would have to come see her during drill in August. Following that I went to my psychiatrist and explained to him what was going on and he took me off of the medication and did would not continue to prescribe anything for me at that time as he is not affiliated with the military and is unaware of what I am allowed to be on. I was told by the recruiting command I couldn't remain in my position as a recruiter and I was moved over to the Mobile Event Team, although the CSM told me that they would have me remain on orders until they're told otherwise. A few weeks later I ended up calling the DPH and the other case manager regarding some questions I had regarding this situation. I asked the DPH why I wasn't being afforded the opportunity to provide the 90-day medication stability letter and he told me that the team at MedDet got together and decided they were not going to allow me to have that opportunity due to my history of receiving behavioral health care. I called the other case manager and asked her what regulations are being used to determine I'm not fit for duty, and she told me that she doesn't know, it's not her job to find out, and that she just does what she's told. During another phone call with the DPH around this time it was brought up that he had called my psychiatrist to inquire about a potential diagnosis of me having bipolar disorder due to the "mood disorder" being in my record from him and my dad having Type 1 bipolar disorder, but the psychiatrist told him he did not have an indication that I did. He also essentially told me that they (I'm assuming the MedDet team) don't want me to fight this process and to just accept it and move on with my life as they don't want me to feel like I need the military.

On June 29th I was placed on a permanent profile for "adjustment disorder" was given a 3 in psych on my PULHES codes, and my MedPros was updated to an MRC3 with a DL 5 code. On July 5th I received my notification of intent to separate for failing to meet medical retention standards for non-duty related condition(s) IAW AR 40-50, and a form to either concur with the decision and request to be discharged, or request my case be reviewed by the NDR-PEB for a fitness determination, which I opted for. July 11th, I signed the paperwork with my unit readiness NCO and a counseling statement for a "disability counseling statement for LOD".

On July 17th the DPH asked me to give him a call and told me one of the other deputy state surgeons wanted to speak with me. She told me that I am not allowed to remain on orders with the recruiting command due to this all, but that I'm supposed to remain on medical orders until this process is complete, and asked if I would be interested in being transferred to the closest Soldier Recovery Unit, which I said yes to. She explained they needed to submit a packet for approval but stated she felt that with my case there was a high probability of it being approved. July 20th, I decided to check my MedPros for no real reason and saw that my profile was updated with a diagnosis of "bipolar disorder". At this point I was starting to believe MedDet was handling everything in a way they're not supposed to, but all conversations at this point had been either in person or over the phone, so I emailed the DPH on the 21st asking for an explanation as to why that diagnosis was added to my profile. I attached a read receipt to the email in which I got a notification for saying he read the email two minutes after I sent it, but he did not respond. Monday the 24th I sent him a follow up email to reiterate my asking for an explanation, who made the decision to put bipolar disorder on my profile, and to send me a copy of the documentation used to make the decision, to which he still did not respond to. Tuesday the 25th I emailed the profiling officer, who's the Deputy State Surgeon asking for the same, and he did not respond. Thursday the 27th I emailed the other case manager, CC'd the DPH and profiling officer, received read receipts from the other case manager and the DPH, but still did not get a response.

I started AT on July 28th, which we're remaining in state for as I'm with the rear det, and we have a lot of down time during it. On Monday the 31st I asked the DPH about coming in during the week to speak with the BHO who did my fit for duty eval notes, as I was told to see her during August drill, and to see the profiling officer, and he asked me about going in on Saturday, August 5th as MedDet is on their AT as well, and I inquired about another day due to being unavailable that day, and he said he'd find out and let me know. He ended up asking what questions I had for them, which I explained I wanted to see the BHO about getting my fit for duty evaluation notes corrected, and that I wanted to see the profiling officer about the "bipolar disorder" diagnosis being added to my profile as I have never been diagnosed with it, and that he had spoken with my psychiatrist several weeks back who told him I do not have it. He called this past Thursday, August 3rd, and said that the BHO and profiling officer were too busy to see me, but that the BHO said she can't fix the notes, and that the profiling officer essentially said because I did not have a definitive diagnosis that was in the AR 40-501 as a medically disqualifying condition, he just reviewed my records he had and decided bipolar disorder was the closest match he could use. I subsequently emailed both the BHO and profiling officer individually that night, CC'd the DPH, and respectfully and professionally explained that I wanted an addendum created for my fit for duty evaluation notes, providing what discrepancies she wrote and what they needed to be corrected to, that I wanted the bipolar disorder diagnosis removed from my profile, with a thoroughly detailed reasoning as to why it wasn't medically appropriate to put on there, asked for an explanation as to why it was put on there to begin with when I was already on a permanent profile for "adjustment disorder" which "chronic adjustment disorder" was already classified as a medically disqualifying condition IAW AR 40-501, as referred to on my notification of intent to separate I received on July 5th before "bipolar disorder" was on my profile, and attached him a letter from my psychiatrist stating I show no clinical indication of mental illness, that he has no diagnosis for me, and that I'm discharged from his care. This past Friday, August 4th, I texted the DPH asking him to send me an updated copy of my Chronological Record of Medical care, and that moving forward I would like all communication to be conducted via text message or email. As of this writing I still not have received responses to any of the emails I sent, nor a response to the text message I sent on Friday, which to me, confirmed my suspicions that MedDet is not managing my case properly, and the reason I'm only receiving information over the phone is due to them not wanting anything they tell me to be documented. I am not making accusations that there is misconduct on their part, only speculation as I do not have any solid evidence to show so.

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At this point in time, I have no significant issue anymore if the Army wants to determine I'm unfit for continued service, but if so, I truly believe it needs to be done via MEB/PEB, not a NDR-PEB. Otherwise, I'm going to fight like absolute hell against this.

I know adjustment disorder itself is classified as a condition not amounting to disability, but chronic adjustment disorder is, which is what I was found to be unfit for based on my notification of intent to separate IAW AR 40-501. In AR 40-502 it states that a DL 5 is indication that MEB action is needed, and on my profile under block "27. Administrative/Medical Board Status" it states "Referred to MEB" but yet I'm being processed for a NDR-PEB, which corresponds with a DL 6. Why is this?

From my understanding, line of duty investigations are used determine eligibility for continued medical care for RC members who incurred an injury/illness/condition while in a qualified duty status. Given that I'm on FTNGD-OTD orders, which already allow me to seek continuous medical care, and that it is expected I'll be approved for transfer to the Soldier Recovery Unit for continue care until my board, is it necessary for a line of duty determination to be done? Why is it that I was counseled for a line of duty investigation after I already received notification that I was found to be unfit for continued service for a non-duty related condition?

DoD Instruction 1332.18, November 10, 2022: Disability Evaluation System, Section 7: Standards for Compensational Disabilities, 7.7: Evidentiary Standards for Determining Compensability of Unfitting Conditions, paragraph (e.) states: "Any medical condition incurred or aggravated during one period of active service or authorized training in any of the Military Services that recurs, is aggravated, or otherwise causes the Service member to be unfit, should be considered incurred in the LOD, provided the origin of such condition or its current state is not due to the Service member’s misconduct or willful negligence, or progressed to unfitness as the result of intervening events when the Service member was not in a duty status." Given there was no misconduct or willful negligence revolving my diagnosis in the Marine Corps, which has a clear service connection that is documented in my behavioral health records from that time, and that I was diagnosed with anxiety disorder, emotional impulsivity, and adjustment disorder with mixed anxiety and depressed mood for a second time, while in a qualified duty status, is/should this be enough for an in-line of duty determination?

*DoDI 1332.18 defines non-duty related medical conditions as "Conditions that were neither incurred nor aggravated while the AC or RC Service member was in a qualified military duty status." and then refers to DoDI 1241.01 for the definition of "qualified duty status"

*DoDI 1241.01 Reserve Component (RC) Line of Duty Determination for Medical and Dental Treatments and Incapacitation Pay Entitlements defines a qualified duty status as "The period of which an RC service member is: On AD or FTNGD for more than 30 days

If an in-line of duty determination is made, which based on the information I know of, should be done, can the NDR-PEB process even continue? Will the process be terminated and processed as a MEB/? Or will I have to wait for the NDR-PEB and they refer it to a MEB?

Given the fact that the profiling officer, without known reason, added a diagnosis of "bipolar disorder" to my profile after it was already established via my medical and verbal confirmation to the DPH from my psychiatrist that I do not have it, can this be brought up as a case of falsifying medical records, assuming the diagnosis is not removed after requesting it and providing a letter from the psychiatrist stating he does not have a diagnosis for me?

Has anyone here ever heard of a situation like this before? At this point what can I even do and what should I do? Apparently the BHO is married to one of the JAG lawyers at our local office, and I don't know if this is something the IG can help with due to the lack of evidence there has been any misconduct. Who should I talk to to address the fact that they're deliberately not responding to anything asked via email or text message?
Posted in these groups: Ems Medical8eb5c10a Legal Services
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Responses: 4
COL Randall C.
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Edited 9 mo ago
Short answer to your situation: What SHOULD be happening right now is that you would be going through the DES process.

Long answer: If you take nothing else away, do this - contact the Office of Soldier’s Counsel*. These are JAGs that are specifically focused on legal advice to those facing PEBs and MEBs and are best suited to give you the advice you are looking for. Don’t seek legal advice from your local JAG in cases like this unless they are part of the OSC (you should have been pointed their way at the beginning of a PEB/MEB) unless it is non-PEB/MEB related.

My second piece of advice is that you REALLY need to work on your “elevator pitch” as about three-fourths of your post can be eliminated so that it’s not distracting from your key points. As SSgt Christophe Murphy said, there is a lot to digest.

I understand you wanting to lay out everything and make an emotional connection with what you’ve gone through, but you need to ensure your key points are communicated instead of relying on the listener/reader to dig them out of the conversation. You’ll have ample opportunity to expand on them. Alternatively, in written communication (like your post), have your key points up front and expand with everything else (additional context) below that.

You are correct that when you’re on active duty (for more than 30 days), the presumption that if anything happens to you it is LOD unless proven otherwise (if not on active duty, it’s reversed). A factor that is probably impacting on you is that your condition is pre-existing to your CURRENT period of active duty and an LOD would be appropriate to determine if your period of active duty aggravated it (i.e., “a permanent worsening of a pre-service medical condition over and above the natural progression caused by trauma or the nature of military service.”)*

HOWEVER, “If an LOD determination has been made during a period of prior military service and the same condition arises in a subsequent period of military service, the prior determination will remain unchanged unless intervening events exist” (AR 600-8-4, Para 2-2b).

Regarding the non-deployable medication, that should not have triggered a MEB. From your description, I assume you’re taking “L” which is one of the medications that make you non-deployable, and that would require you to be issued a temporary BH profile (they don’t have PULHES designations) for 90 days to be renewed while on the medication*. It would have been raised to the Commander to monitor and counsel you, but until determined that you had a permanent condition requiring the medication (and an alternative can’t be substituted) or the temporary profile went over 365 days, it wouldn’t trigger a MEB.

This is immaterial as you stated you were placed on a P3 profile in June, and that would automatically trigger a referral to the DES.

However, the Marine Corps did render an evaluation that an “Adjustment disorder with mixed anxiety and depressed mood” (F43.23) was NOT a disabling condition (otherwise they would have never started with a "convenience of the government/condition not a disability" separation. If it was determined to be a disability condition they would have referred you to a DES.

BTW, the "failure to adapt" should have never entered the picture when you were in the Marines. That's for Entry-level separations, not for someone that has been in the military for over seven years.

Too many confusing parts – you REALLY need to discuss the issue with the OSC.
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* Office of Soldier’s Counsel - https://www.jagcnet.army.mil/Sites/OSC.nsf/#
* LOD determinations - https://armypubs.army.mil/epubs/DR_pubs/DR_a/ARN33106-AR_600-8-4-001-WEB-2.pdf
* https://www.health.mil/Reference-Center/Policies/2013/10/07/Deployment-Limiting-Mental-Disorders-and-Psychotrophic-Medications
* MEDCOM Policy Memo 21-019, Behavioral Health eProfiling - https://ga.ng.mil/portals/49/g1/documents/MEDICAL/12BH/POLICY%2017-079%20(Behavioral%20Health%20eProfile).pdf
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MAJ Intell Officer
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Edited 9 mo ago
A lot to digest and unpack here...
~ I'm curious to know why you would joint the NG as a recruiter if that was/is the cause of your BH?
~ You are required to disclose medication because there are specified drugs that Soldiers cannot take for deployability reasons. There are also conditions that make you unfit for duty. (Sounds like you have done some research - DODI 6130.03, AR 40-501)
~ It is true you cannot stay on ADOS orders for duty that you cannot perform. There are medical ADOS orders available to keep you on active duty for treatment purposes. You mentioned SRU, but it is a packet process and the entry requirements have changed. You would be elligible if you do not have a 3 in your PULES. A 3 in your profile should trigger a MEB.
~ You are entitled to a copy of all your military records (by written request), but there is no written requirement that forces provides to talk with you or disclose why they made a recommendation in your case.
~ LODs are used by the NG and reserve to document injuries and adjitated conditions that happened while on active duty because care does not always get recorded through military systems. It is used for continued care and after care through the VA. Seperate from MEB/PEB but taken into consideration for medical retention/discharge.
~A PEB typically occures after a MEB has made a ruling. You should have a case manager assigned to you that is tracking your case and can explain the process.
https://ga.ng.mil/portals/49/g1/documents/MEDICAL/11NDRPEB/PEB%20(FAQs).pdf
~ IG cannot assist unless there is a violation of policy.
~ There is nothing wrong with BHO being married to a JAG, unless they are both working on your case. The local JAG office does not usually work on MEB/PEB cases.
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SSgt Christophe Murphy
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That's a lot to digest. I honestly think you probably should have been put through a MEB when you were still in the Marine Corps. I also think your NG Command is doing damage control because you got out of the Corps for basically the same issues you are having now. The one common thread is recruiting and I would lean into that causing the issues you have been suffering. Good Luck
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