BOARD DATE: 23 July 2014 DOCKET NUMBER: AR20140010511 THE BOARD CONSIDERED THE FOLLOWING EVIDENCE: 1. Application for correction of military records (with supporting documents provided, if any). 2. Military Personnel Records and advisory opinions (if any). THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE: 1. The applicant requests a review of the military disability evaluation pertaining to a mental health (MH) condition. 2. The applicant states, in effect, the case file should be reviewed in accordance with the Secretary of Defense directive for a comprehensive review of members who were referred for a disability evaluation between 11 September 2001 and 30 April 2012 and whose mental health diagnosis was changed during that process. 3. The applicant submitted an application through the DOD Physical Disability Board of Review (PDBR) Mental Health Special Review Panel (SRP). CONSIDERATION OF EVIDENCE: 1. The PDBR SRP conducted a comprehensive review of the applicant’s submissions and records for evidence of inappropriate changes in the diagnosis of a mental health condition during processing through the military disability system. 2. The Department of Defense memorandum, dated 27 February 2013, directed the Service Secretaries to conduct a review of mental health diagnoses for service members completing a disability evaluation process between 11 September 2001 and 30 April 2012 in order to determine if service members were disadvantaged by a changed diagnosis over the course of their physical disability process. 3. In the processing of this case, an advisory opinion was obtained from the PDBR SRP and the applicant was provided a copy. 4. The applicant did not respond to the advisory opinion. DISCUSSION AND CONCLUSIONS: 1. After a comprehensive review of the applicant’s case, the SRP determined by unanimous vote that there should be no change of the applicant’s disability and retirement determination. 2. The SRP considered the appropriateness of changes in the MH diagnoses; the physical evaluation board (PEB) fitness determination; and if unfitting, whether the provisions of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 were applicable; and whether a disability rating recommendation in accordance with VASRD Section 4.130 was made. 3. The SRP reviewed the records for evidence of inappropriate changes in diagnosis of the MH condition during processing through the military Disability Evaluation System (DES). The SRP noted that Post-Traumatic Stress Disorder (PTSD) was mentioned as a diagnosis by the Cedar Springs Hospital in its discharge summary which was written while the applicant was in the DES process. Additionally, the psychologist who performed the fitness for duty evaluation for the medical evaluation board (MEB) had first diagnosed adjustment disorder as meeting medical retention standards and then several months later, following the applicant's hospitalization, the diagnosis was changed to undifferentiated somatoform disorder which was considered to not meet medical retention standards. The SRP concluded that the applicant’s case did meet the inclusion criteria of the Terms of Reference of the MH Review Project. The SRP later turned to a discussion of the appropriateness of the MH diagnosis. 4. The SRP noted that a diagnosis of pain disorder associated with psychological factors was made following the applicant’s medical evacuation medevac) from deployment for scrotal pain. Undifferentiated somatoform disorder was confirmed by psychological testing performed in March 2010 and again in the MH consult performed for the MEB in May 2011. Additionally, anxiety disorder was a consistent diagnosis throughout the DES. Although the Cedar Spring Hospital had diagnosed PTSD along with major depressive disorder (MDD) and anxiety disorder in its discharge summary, the record did not contain significant detailed data supporting the PTSD diagnosis in the summary. 5. The SRP considered the criteria for diagnosis according to the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV TR) including: the evidence for the stressor (criterion A), re-experiencing of the event (criterion B), persistent avoidance of stimuli associated with the trauma (criterion C), hyperarousal (criterion D), duration and onset (criterion E), and presence of clinically significant distress or impairment in social, occupational or other important area of functioning (criterion F). The retention evaluation performed in May 2011 specifically disputed the PTSD finding, pointing out that the applicant had not complained of symptoms related to avoidance (criterion C), hypervigilance (Criterion D) or re-experiencing (Criterion B) thus not meeting the DSM-IV criteria for that diagnosis. Additionally, the VA Compensation and Pension (C&P) examiner had stated that the applicant “did not report nor demonstrate any signs or symptoms of PTSD.” The SRP concluded that the hospital discharge summary was of lesser probative value and that there was not a preponderance of evidence to support any change in diagnosis to PTSD. 6. The SRP later considered whether the MH conditions, regardless of specific diagnosis, were unfitting for continued military service. The SRP’s charge with respect to MH conditions referred for review that were determined to be not unfitting by the PEB was an assessment of the appropriateness of the PEB’s fitness adjudication. The SRP’s threshold for countering PEB not unfit determinations required a preponderance of evidence. The SRP discussed the fact that pain disorder was documented by the urologist after the applicant’s medevac for scrotal pain at the beginning of the process which led to the DES. While post-traumatic headaches was a focus of concern, undifferentiated somatoform disorder would likely have been a factor in the applicant’s experiencing of this problem (and potentially other physical problems as well). 7. The SRP considered it was possible that undifferentiated somatoform disorder could potentially be seen as a separately unfitting condition causing impairment in military/occupational functioning as well as contributing to the subjective experience of even physician-established somatic disorders. In this regard, members noted the commander’s report that he had “not observed any negative emotional issues with [the applicant]” but also discussed the fact that undifferentiated somatization disorder would likely have caused the applicant to complain of physical symptoms as opposed to more obviously “emotional” symptoms such as anxiety or depression. 8. The SRP noted the service psychologist’s opinion in March 2010 and as late as February 2011 that there was no MH condition that fell below medical retention standards, although that opinion appeared to have changed in the MEB psychiatry report of May 2011 (does not meet retention standards) and the MEB dated 30 August 2011. The VA rating decision of November 2011, while recommending a service-connected disability rating of 30 percent for “undifferentiated somatoform disorder, anxiety disorder and adjustment disorder with depressed mood,” stated in spite of the August 2010 exam reflecting more severe impairment review of the records revealed symptoms were well treated and the performance statement did not reflect impairment of work efficiency. 9. The SRP also considered that there was adequate performance until referral (in accordance with (IAW) Department of Defense Instruction (DODI) 1332.38, E3.P3.3.3) attributable to any MH condition or symptoms. Overall, the SRP adjudged that the preponderance of the evidence supported that no MH condition, regardless of diagnosis, rose to the level of being unfitting at the time of separation. 10. After due deliberation in consideration of the preponderance of the evidence, the SRP concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the MH condition and no disability ratings was recommended. 11. The available evidence shows the SRP’s assessment should be accepted. BOARD VOTE: ________ ________ ________ 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. _________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. ABCMR Record of Proceedings (cont) AR20040003532 3 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1 ABCMR Record of Proceedings (cont) AR20140010511 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1