IN THE CASE OF: BOARD DATE: 3 December 2014 DOCKET NUMBER: AR20140018848 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 temporary and permanent retirement determinations. 2. The SRP considers the appropriateness of changes (if any) in the MH diagnoses and the appropriateness of physical evaluation board (PEB) fitness determinations for any MH condition. Since the medical evaluation board (MEB) psychiatric consultant opined that major depressive disorder (MDD) was an independent diagnosis, and the PEB held that it was secondary to the separately rated non-MH conditions, the applicant’s case did meet the inclusion criteria in the Terms of Reference of the MH Review Project. 3. The SRP noted a core issue in the applicant’s case was whether the PEB’s determination regarding the relationship of the MH conditions to the non-MH conditions was fair. The SRP standard for resolving this issue was that a preponderance of evidence must support a contrary recommendation to a PEB determination of this nature. As per the excerpted psychiatric opinion to the PEB, the decision distills to the question of whether the depression was more accurately attributed as mood disorder due to a general medical condition or as an independent diagnosis of MDD. Without elaboration of specific details here, the SRP reviewed the diagnostic criteria for each of these diagnoses. 4. The symptoms themselves overlap the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), criteria of both diagnoses. The key distinction was an etiologic relationship between the depressive symptoms and the general medical condition. Although the MEB psychiatrist formulated a strong opinion regarding the independence of the MDD from the non-MH conditions in the PEB appeal, his own examination at a time when the issue was not being contested documents a firm link between the pain and disability from the medical conditions and the depression, noting a “reciprocal relationship” between the severity of the non-MH and MH symptoms, and the record well establishes that the depression arose in the setting of chronic pain and disability with no preceding psychiatric history. Specifically, the significant MH-related occupational limitations cited in the appeal were not corroborated by the author’s narrative summary (NARSUM) contemporaneous with PEB referral (with some areas of contradiction), nor were they reflected in the officer evaluations. The appeal expressed an opinion that a significant depressive disorder would remain even with resolution of the pain, but the SRP agreed that this conclusion was overly speculative. It was easily conceded that the depression evolved into a separately diagnosable condition, but that begs the question of whether it was “due to” the medical condition. 5. The SRP considered that the only Service psychiatric opinion addressing this issue supported the position that MDD was a separately ratable condition but must also consider the divergence between the examiner’s MEB evaluation and his later opinion in the context of supporting the applicant. The Department of Veterans Affairs psychiatric examination did not address this issue. The second MH diagnosis of chronic pain disorder is indisputably attributable to the rated non-MH diagnoses. 6. After due deliberation in consideration of the preponderance of the evidence, the SRP did not support a recommendation that MDD was independent of, and not attributable to, the rated medical conditions and it was thereby not eligible for consideration for service rating under the Disability Evaluation System provision applied and upheld through subsequent reviews by the service PEB. 7. 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) AR20140018848 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1