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Name: STEBBINS, RL
Dx: ROUTING AND
TO:
TRANSMITTAL SLIP
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土
1. M.O.
doing board
2. SMO
3. Medical Boards
4. Recruit Personnel
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DATE:
Initials
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Date
DI-
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+ 2Da 97
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+ FILL-OUT AND SIGN DISCHARGE MEMO WITH RECRUIT, SEND RECRUIT TO
MEDICAL BOARDS WITH PACKAGE.
MEDICAL OFFICER SHOULD KEEP H.R. TO COMPLETE NARRATIVE SUMMARY.
FROM: HS2 T.A. DEVORE
MEDICAL BOARDS
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Phone no
Ext 6867 .
NSN 7540-00-634-4176
600-108
HEALTH RECORD
CHRONOLOGICAL RECORD OF MEDICAL CARE
DATE
SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)
05 DEC 97
USCG TRACEN CAPE MAY. NJ
RECRUIT
DISCHARGE
SUMMARY
SHEET
DISQUALIFYING DIAGNOSIS:
1. Dissociative Disorder
2. Somatization
This evalue does not meet the minimum standards for enlistment and retention
In the U.S. Coast Guard per COMDINST M6000.1b section: 5-B-13a, 5-B-12c
MECOM CODE: B
PROGNOSIS FOR FUTURE MILITARY SERVICE IS : POOR
COMMENTS: SR Stebbins is a 19y/ow/a first evaluated on 14 Nov 97 after being
found on the bathroom floor in a prone position at approximately 0420hrs.
SR
Stebbins was initially unresponsive and demonstrated an apparent contusion to
the forehead. Following trauma precautions the SR was transferred to the
local hospital for further evaluation.
Soon after arriving at the hospital
the member regained conciousness.
He appeared confused and failed to recall
any events preceeding the accident. A complete evaluation failed to reveal
any evidence of cervical neck or CNS trauma.
Lab studies were normal: The
apparent contusion remained a small reddened area on the anterior forehead devoid of ecchymosis, tenderness
or skin abrasion.
The SR was discharged to
the Coast Guard with the diagnosis of psychogenic amnesia.
The SR was
immediately evaluated by the staff psychologist.
The evaluation was normal
with
no evidence of residual neurolgical deficits. Due to
the unusual
presentation without evidence or confirmation of brain trauma
to explain the
PATIENT'S IDENTIFICATION
course
of
events the SR was transferred via ambulance tol
--cont--
Imprint)
(Use this space for Mechanical
RECORDS
MAINTAINED
TRAINING CENTER CAPE MAY NJ PATIENT'S NAME (Last, First, Middle Initia)
Stebbins.
Richard
RELATIONSHIP TO SPONSOR
SELF
SPONSOR'S NAME
DEPART/SERVICE
DOT / USCG
CHRONOLOGICAL RECO
STATUS
ACTIVE
SEX
MALE
RANK/GRADE
SR / E - 1
ORGANIZATION
CG TRACEN CAPE MAY
DATE
SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)
05 Dec 97
--contーー WRAMC for further
evaluation.
The SR remained at WRAMC for five days where a
complete neurological and psychiatric evaluation was conducted.
It was
concluded there was no evidence of brain trauma or any other evidence of
organic disease
to support the persistant global amnesia.
The psychiatric
evaluation of 21 Nov 97 concluded the amnesia was more probably moderated by a
superimposed psychiatric disorder associated with a dissociate disorder and
did not confirm to typical amnestic patterns noted following brain
injury.
The SR was returned to Tracen Cape May with the recommendations that he
continue psychological counseling due to the psychological rather than organic basis for his amnesia. He was not
considered suitable to return to training.
SR Stebbins was sent to Cape May counseling on 1 dec 97 for a follow up
evaluation. He was not considered a threat to himself or others.
During the
two week period since returning to Tracen SR
Stebbins was kept as an inpatient
on the ward.
During this time he regained his memory and is now aware of his
family and past historical events.
He remains ambigious as the nature of his
accident but has stated he did not fall or hit his head. He believes he has
and has had psychological problems
and wishes only to be released from the
CG.
He has expressed a
fear of thr training environment although he does not
understand the reasons why he feels that way. SR Stebbins remains anxious
and
apprehensive but has not expressed any suicidal thoughts.
SR Stebbins anxiety has led to some minor confrontations with the staff
and training
officers.
SR Stebbins is found not suitabloe for continued
military service due to the psychological nature of his problem and
underlying
emotional
tendencies for denial and somatization.
SR Stebbins is recommended for
immediate seperation for the interest of his mental well being. M.E. FAJARDO,
MD. CAPT. USPHS
Fol
capt tajardo
LCDR M. K. Dollymore
M.D., USPHS
STANDARD FORM 600 PAGE 2 (Rév. 5-84)
U.S. Department
of Transportation
United States
Coast Guard
Memorandum
Subject: MEDICAL DISCHARGE NOTICE/ACKNOWLEDGMENT Date:
2DEC DEC97
6610
From: Senior Medical Officer
Reply to: K
Attn. of:
PO Devore
X6867
To: Commanding Officer, Coast Guard Training Center Cape May
Via: (1) Recruit
(2) Regimental Officer
(3) Training Officer
Ref: (a) Medical Manual, COMDTINST M6000.1B 1.. In accordance with reference (a), the recruit named below is
recommended for discharge from the U
S. Coast Guard for the
following medical condition(s):
R/O DISSASSOCIATENVE DISONDEr
2. The Medical Officer assigned to complete this medical board is:
LTJG DAVIS
First Endorsement
From:
SR R.L. STEBBINS 1. I have been notified that I have been recommended for
discharge.
2. I do / do not
desire to request a waiver. 3. I do / do not desire to submit a written statement in
rebuttal to the above diagnosis.
1. I do / do noD desire to speak with the Commanding Officer. I do do not give permission to release any information to
con ernividual sch age spook ormy relatives friend. 6.
This document supersedes any previous election I made prior to
this action.
Wid detes.
Recruit
Sonature
Witness
Signature
2DEC97
Date
20ue 97
Date
HEALTH RECORD
DATE
600-108
CHRONOLOGICAL RECORD OF MEDICAL CARE
SYMPTOMS, DIAGNOSIS, TREATMENT IREATING ORGANIZATION (Sign each entry)
USCG TRACEN CAPEMAY, NJ. 08204
SUBSTITUTION PHYSICAL EXAMINATION
DATE: 5 DEC 97
PURPOSE: DISCHARGE
RECOMMENDATION: FFD I DENY ANY INJURY OR ILLNESS AT THIS
PRESENT TIME:
SIG:
WITNESS
Selle
A DEVORE, NS, USCG
LCDR M. K. Dollymore
MEDICĂL OFFICER SIGNATI
For Capt M. Fajardo A BENTSTENTIFICATION Use this soace for Mechanical
Imprint)
RECORDS
MAINTAINED
PATIENT'S NAME (Last, Pinst, Middle initiat)
STEBBiNS
RELATIONSHIP TO SHONSOR
SPONSÖR'S NAME
DEPART SERVICE ISN/DE
DOT
STATUS
AD/ CG
SEX
M
RANK/ GRADE
SR/E1
ORGANIZATION TRACEN CPVY, NJ
RTH
