RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS
IN THE MATTER OF: DOCKET NUMBER: BC-2013-00990
XXXXXXX COUNSEL: LISA MARIE WINDSOR, ESQ.
HEARING DESIRED: YES
________________________________________________________________
APPLICANT REQUESTS THAT:
His discharge with severance pay be changed to a permanent
retirement with a 50 percent disability rating for Delusional
Disorder and Post-Traumatic Stress Disorder (PTSD).
________________________________________________________________
APPLICANT CONTENDS THAT:
The applicant, thru counsel, contends that disagreements made by
the mental health professionals in his case have made it
virtually impossible for him to argue that both his disabilities
are unfitting, ratable and compensable. The applicant testified
at the Formal Physical Evaluation Board (FPEB) that he had been
suffering from symptoms of PTSD since he returned from
deployment in 2006 and wanted to remain on active duty.
He was afraid of the stigma associated with mental illness and
did not seek treatment at the time. The evidence supports that
both Delusional Disorder and PTSD were present, unfitting and
compensable at the time the applicant was placed on the TDRL.
He was given a battery of tests by a clinical social worker who
diagnosed him with Delusional Disorder based on his unrequited
love and unrealistic pursuit of a woman in his graduate school
class. The clinical social worker pursued his singular
diagnosis of Delusional Disorder, despite his consistent
complaints of PTSD symptoms as evidenced in the notes of other
providers. His treating physician acknowledges the possibility
of Delusional Disorder but states that he has not personally
observed any delusional behavior.
The has a history of family mental illness (schizophrenia), and
a personal history of Traumatic Brain Injury (TBI). He was in a
vehicle that was hit by an Improvised Explosive Device and at
another time he was in the vicinity of a suicide bomber attack
and almost stepped on the bomber's severed head.
He currently works at a job that he gained through vocational
rehabilitation services. The vocational rehabilitation
counselor details the difficulty he has had due to post
concussive syndrome and his struggles to improve memory,
concentration and the ability to problem-solve. His condition
has not improved since 2009, and he still suffers from
significant PTSD symptoms, including nightmares, sleep
deprivation, hyper-vigilance, and recurrent intrusive thoughts.
He acknowledges maintaining an isolated lifestyle, having no
social life and rarely venturing out unless he is going to work.
In Jul 2010, he received a 60 percent disability rating from the
Department of Veterans Affairs (DVA), with 50 percent for "PTSD
also claimed as Delusional Disorder and memory loss."
Medical opinions since 2008 have differed in mental health
diagnosis, but agree that the applicant evidences a significant
inability to function. His history of reported memory loss,
inability to concentrate, impaired thinking, motivational and
mood disturbances and difficulty in establishing and maintaining
effective work and social relationships fits the criteria
according to the Veterans Administration Schedule for Rating
Disabilities (VASRD) of at least a 50 percent disability rating.
In support of his request, the applicant provides copies of his
AF Forms 356, Findings and Recommended Disposition of USAF
Physical Evaluation Board; DVA Rating Decision; DD Form 214,
Certificate of Release or Discharge from Active Duty; VA Form 9,
Appeal to Board of Veterans Appeals; Standard Forms 600,
Chronological Record of Medical Care, and various other
documents associated with his request.
His complete submission, with attachments, is at Exhibit A.
________________________________________________________________
STATEMENT OF FACTS:
On 24 Jun 2009 the applicant was deemed unfit for military duty
and was placed on the Temporary Disability Retirement List
(TDRL) with a 50 percent disability rating for Delusional
Disorder.
According to the 7 Jul 2010, DVA Rating decision provided by the
applicant the DVA granted him a 50 percent rating for PTSD also
claimed as Delusional Disorder with memory loss.
On 7 Feb 2012, the Informal Physical Evaluation Board (IPEB)
rated the applicants Delusional disorder, Erotomanic Type, in
control off medication, and recommended discharge with
severance pay with a disability rating of zero percent.
On 24 Apr 2012, the FPEB upheld the IPEB decision.
On 24 Sep 2012, the applicant was separated from active service
for physical disability under the provisions of 10 United States
Code (USC) § 1203, with severance pay and a disability rating of
10 percent. He had 19 years, 3 months and 23 days of active
duty.
The remaining relevant facts pertaining to this application are
contained in the letters prepared by the appropriate offices of
the Air Force and the BCMR Medical Consultant at Exhibits C and
D.
________________________________________________________________
AIR FORCE EVALUATION:
AFPC/DPFD recommends denial. DPFD states that the preponderance
of evidence reflects that no error or injustice occurred during
the disability process or at the time of separation. In
accordance with DoDI 1332.38, Physical Disability Evaluation,
E3.P6.2.4. Compensability of New Diagnoses, when there is a new
condition for which the service member was not placed on the
TDRL, the PEB may find the condition ratable and compensable if
the condition was caused by the condition for which the member
was placed on the TDRL, or directly related to its treatment, or
the evidence of record establishes that the condition was an
unfitting disability at the time the member was placed on the
TDRL.
The applicant testified he did not miss any work due to his PTSD
while in service. DVA evaluation notes dated 22 Jan 2009, state
that he reported symptoms of flashbacks, nightmares, and at
times he emotionally withdraws, but states that these
occurrences do not hinder his current life. Since being
placed on the TDRL, the applicant has maintained a full time
position with the Department of Treasury. He takes no
medications for his condition but continues to function
adequately without it. He reported that he did not feel he
needed any medications for his mental health condition.
Although he testified he works from home an average of 1-2 days
a week due to distress, he related this distress to PTSD
symptoms, not to his Delusional Disorder. The FPEB found the
applicants Delusional Disorder does not interfere with
occupational and social functioning which decrease work
efficiency and ability to perform tasks. However, his condition
continues to be unfitting for military service as routine
military duty and deployment stressors could exacerbate his
condition with deterioration in functioning.
Although the applicant submitted a copy of his DVA disability
rating, the FBEB opines this disability rating, awarded on
initial separation from service, is insufficient for purposes of
determining the most appropriate current disability rating and
thus refers to the recent TDRL evaluation and more recent DVA
and medical treatment notes for rating determination purposes.
The FPEB recommended discharge with severance pay with a
disability rating of zero percent in accordance with the VASRD
guidelines. The Department of Defense and the DVA disability
evaluation systems operate under separate laws. The Air Force
disability boards must rate disabilities based on the member's
condition at the time of evaluation. It is the charge of the
DVA to pick up where the Air Force must, by law, leave off.
Under Title 38, the DVA may rate any service-connected condition
based upon future employability or reevaluate based on changes
in the severity of a condition.
The complete DPFD evaluation is at Exhibit C.
The BCMR Medical Consultant recommends denial of the applicant's
request for inclusion of PTSD as unfitting at the time of his
initial placement on the TDRL. The Medical Consultant
alternatively recommends consideration for permanent retirement
with a 30 percent disability rating due to Delusional Disorder,
effective the established date of his removal from the TDRL.
Existing Department of Defense policies prohibit the inclusion
as unfitting any newly diagnosed medical condition or a
previously diagnosed condition that was not determined unfitting
or was not caused by the condition found unfitting at the time
of initial placement on the TDRL. The applicant's service
treatment record indicates he reported signs and symptoms that
can be attributed to PTSD prior to his placement on the TDRL.
Even though the military provider believed that the applicant
did not meet the criteria for the diagnosis of PTSD, in order
for the condition to be included in the disability rating
computation, it would have to be determined unfitting for
further military service at the time of initial TDRL placement;
or found to be secondary to or the direct result of the
Delusional Disorder. Despite the clinical history provided to
the DVA examiner, the applicant's supplied service evidence of
record does not reflect the applicant's PTSD was the condition
that resulted in his referral to the military Disability
Evaluation System (DES).
Although the Medical Consultant and the Board have been
confronted with "dueling doctors" opinions, the preponderance of
evidence reflects it was the applicant's Delusional Disorder and
not his PTSD that significantly interfered with his duties
resulting in his release from active military service.
Nevertheless, the Boards attention is also directed to the
matter of the TDRL narrative summary, which clearly states the
applicant's level of impairment in social and industrial
adaptability for his Delusional Disorder was "Definite." Such a
designation by a mental health provider is generally accepted by
adjudicating bodies as consistent with a 30 percent disability
rating. The applicant's self-report of full-time work and his
lack of need for medications to control his condition, likely
led to the reduced rating decision of "0 percent" by the IPEB
and FPEB; although subsequently increased to 10 percent by
SAFPC. Moreover, although the DVA appears to have discarded
Delusional Disorder as the primary diagnosis, as noted in its
rating description of the condition as "PTSD also claimed as
Delusional Disorder," it does not change the fact that
Delusional Disorder was the condition that cut short the
applicant's career at the "snap shot" time of his placement on
the TDRL. Indeed, the rationale for the DVA rating decision for
PTSD acknowledges the Delusional Disorder, but in no way
illustrates a causal relationship between the two in the
following: "Service connection for PTSD also claimed as a
Delusional Disorder and memory loss has been established as
directly related to military service. The DVA examination
revealed a diagnosis of PTSD which the examiner linked to the
applicants military service.
The reader is reminded that, operating under Title 38, USC, the
DVA is authorized to offer compensation for any medical
diagnosis of record with a nexus to military service, without
regard to and independent of its relationship with a member's
retainability or fitness to serve. The Medical Consultant found
no causal relationship between the applicant's PTSD and the
performance of his duties nor as a cause for terminating his
career. However, in order to remedy a possible injustice to the
applicant, the Medical Consultant recommends amending the record
to reflect that the applicant was permanently retired with a 30
percent disability rating due to the definite impairment caused
by his Delusional Disorder. Conversely, if the argument stands
that the applicant no longer has symptoms or a functional
impairment due to Delusional Disorder, then the 10 percent
rating reissued by SAFPC should stand. The Board should also be
aware that a Delusional Disorder diagnosis is considered a
thought disorder that could be a comparative occupational
detriment [although not presently] to the applicant, as opposed
to PTSD, a mood disorder, albeit a factual diagnosis in the
record.
The complete Medical Consultants evaluation is at Exhibit D.
________________________________________________________________
APPLICANT'S REVIEW OF AIR FORCE EVALUATION:
Regarding the diagnosis of PTSD, counsel states that no matter
how severe his condition became it does not appear the applicant
sought out mental health treatment and may not have ever done so
absent the command referral. From his first visit to mental
health he complained of symptoms associated with combat-related
PTSD and was referred to a psychologist or psychiatrist for an
evaluation. The psychologist communicated to the social worker
who referred him that he had made a diagnosis of combat-related
PTSD. As PTSD is a severe mental condition and potentially
service-unfitting, the condition should have been assessed and
considered by the MEB. Counsel agrees that the determination of
unfitness is a snapshot of the applicants condition at the time
of separation, but it must also be an accurate snapshot. Any
potentially unfitting condition should be evaluated by a
military physician for possible referral to a MEB, if it is
known. The determination of whether the applicants combat-
related PTSD rendered him unfit was not accomplished at the time
of his placement on the TDRL, and it is within the Board's
authority to make that determination now based on the medical
reports he received at the time.
Given his current level of impairment and self-reports of
combat-related PTSD symptoms, the likelihood that he would have
eventually been separated from the service for combat-related
PTSD is probable and counsel argues that combat-related PTSD
should be added as a service unfitting medical condition for the
purposes of a disability rating. Counsel agrees with the BCMR
Medical Consultants recommendation regarding the diagnosis of
Delusional Disorder. Therefore, counsel requests the Board
disregard the AFPC/DPFD advisory opinion and adopt the rationale
of the BCMR Medical Advisor. In the hope that the Board will
have a better understanding of the complexities of combat-
related PTSD and Delusional Disorder; counsel guides the Board
to review the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (DSM-V).
In further support of his request, counsel provided copies of
the DVA rating decision for TBI, progress notes and DSM-V
The complete response, with attachments, is at Exhibit F.
________________________________________________________________
THE BOARD CONCLUDES THAT:
1. The applicant has exhausted all remedies provided by
existing law or regulations.
2. The application was timely filed.
3. Insufficient relevant evidence has been presented to
demonstrate the existence of an error or injustice. We took
notice of the applicant's complete submission in judging the
merits of the case and do not find that it supports a
determination that the applicant should have received a
50 percent disability for PTSD and Delusional Disorder. The
applicant has provided no evidence which, in our opinion,
successfully refutes the assessment of his case by the BCMR
Medical Consultant. Therefore, we agree with the recommendation
of the BCMR Medical Consultant and adopt his opinion as our
findings in this case. In the absence of evidence to the
contrary, we find no basis to recommend granting this portion of
his application.
4. Notwithstanding the above, sufficient relevant evidence has
been presented to demonstrate the existence of an error or
injustice warranting partial relief. The thorough analysis
performed by the BCMR Medical Consultant has raised sufficient
doubt as to whether the applicant's 10 percent disability rating
for his Delusional Disorder was correct. As pointed out by the
BCMR Medical Consultant, the applicants level of impairment in
social and industrial adaptability for his Delusional Disorder
was Definite, is generally accepted by adjudicating bodies as
consistent with a 30 percent disability rating. As such, we
believe the applicant's medical condition may not have been
rated properly at the time of his separation. Therefore, in the
interest of equity and justice, we recommend the applicants
records be corrected to reflect that he was medically retired
from the Air Force by reason of a physical disability rather
than Disability, Severance Pay. Accordingly, we recommend his
records be corrected to the extent indicated below.
5. The applicant's case is adequately documented and it has not
been shown that a personal appearance with or without counsel
will materially add to our understanding of the issue(s)
involved. Therefore, the request for a hearing is not favorably
considered.
________________________________________________________________
THE BOARD RECOMMENDS THAT:
The pertinent military records of the Department of the Air
Force relating to APPLICANT, be corrected to show that:
a. On 23 Sep 2012, he was found unfit to perform the duties
of his office, rank, grade, or rating by reason of physical
disability, first incurred while he was entitled to
receive basic pay; that the diagnosis in his case was
"Delusional Disorder, VASRD Code 9208, that the degree of
impairment in social and occupational adaptability was definite;
that the disability was not due to intentional misconduct or
willful neglect; that the disability was not incurred during
a period of unauthorized absence; and that the disability was
not received in the line of duty as a direct result of armed
conflict or caused by an instrumentality of war.
b. On 24 Sep 2012, the applicant was not separated by reason
of Physical Disability with a compensable rating of 10 percent,
but, on that date he was removed from the Temporary Disability
Retirement List and permanently retired with a 30 percent
disability rating.
c. The election of Survivor Benefit Plan option will be
corrected in accordance with the member's expressed preferences
and/or as otherwise provided for by law or the Code of Federal
Regulations.
________________________________________________________________
The following members of the Board considered this application
in Executive Session on 5 Dec 2013, under the provisions of AFI
36-2603:
, Panel Chair
, Member
, Member
All members voted to correct the record as recommended. Due to
the unavailability of Mr. Janosov, Mr. Pollock will sign as
Acting Panel Chair. The following documentary evidence was
considered in AFBCMR BC-2013-00990:
Exhibit A. DD Form 149, dated 15 Feb 2013, w/atchs.
Exhibit B. Applicant's Master Personnel Records.
Exhibit C. Letter, AFPC/DPFD, dated 23 Apr 2013.
Exhibit D. Letter, BCMR Medical Consultant, dated 6 May 2013.
Exhibit E. Letter, SAF/MRBC, dated 7 May 2013.
Exhibit F. Letter, Counsel, dated 5 Jun 2013, w/atchs.
Acting Panel Chair
FOR OFFICIAL USE ONLY PRIVACY ACT OF 1974
8
FOR OFFICIAL USE ONLY PRIVACY ACT OF 1974
AF | BCMR | CY2013 | BC 2013 02749
The complete DPFD evaluation is at Exhibit C. The BCMR Medical Consultant recommends amending the applicants record to reflect he was removed from the TDRL and permanently retired with a 50 percent disability rating due to PTSD, under VASRD Code 9411, effective 12 March 2012. While the Medical Consultant recommends granting the applicant the 50 percent rating, he does not believe this should be based upon the documentation from the DVA; as this evidence was the same old evidence utilized...
AF | PDBR | CY2011 | PD2011-00339
The most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case are the TDRL narrative summary (NARSUM), performed eleven months prior to TDRL exit, the FPEB testimony recorded on the FPEB rationale, the VA psychiatric exam performed four months after TDRL exit, and several VA outpatient notes within one year of TDRL exit that contribute to the CI’s impairment picture at final separation. The examiner diagnosed major depressive disorder...
AF | PDBR | CY2013 | PD-2013-02202
At TDRL entry, the PEB rated the condition of conversion disorder, coded 9424, at 10%. The Board further recommends a 30% permanent disability rating for the condition of somatization disorder. TDRL neurology removal examination dated 3 February 2006, approximately 17 months after TDRL entry, recorded decreased sensory in left digits four and five, and pain on palpation of the surgical scar.
AF | BCMR | CY2013 | BC 2013 01627
The remaining relevant facts pertaining to this application are contained in the letters prepared by the appropriate offices of the Air Force, which are at Exhibits C and E. _________________________________________________________________ AIR FORCE EVALUATION: AFPC/DPFD recommends denial indicating there was no evidence of an error or injustice that occurred during the disability process. The USAF disability boards must rate disabilities based on the members condition at the time...
AF | BCMR | CY2013 | BC-2013-00942
Additionally, the Department of Defense (DoD) and the DVA disability evaluation systems operate under separate laws. In addition, if the rating reflects a snapshot of the members condition at the time, then the vast disparity between the assessment of the DVA and the assessment of the doctor must be addressed as both examinations occurred during the same time period and addressed the exact same medical condition of Major Depressive Disorder. Further, there is no apparent relationship...
AF | BCMR | CY2014 | BC 2014 00505
STATEMENT OF FACTS: The applicant is a former member of the Air Force. The IPEB reviewed the applicant's third TDRL re-evaluation on 27 June 2013, and recommended he be removed from TDRL and discharged with severance pay with a disability rating of 10%. The findings were sent to the applicant on 5 July 2013 noting his election statement should be received by 30 July 2013; it would be understood that he agreed with the recommendation of the IPEB, and officials within the Office of the...
ARMY | BCMR | CY2014 | 20140013449
The PDBR SRP conducted a comprehensive review of the applicants submissions and records for evidence of inappropriate changes in the diagnosis of a MH condition during processing through the military disability system. After a comprehensive review of the applicants case, the SRP recommend by unanimous vote that the applicant's prior MH rating determinations be modified to reflect a Temporary Disability Retired List (TDRL) entry at 50 percent for his MH condition, for a combined TDRL entry...
AF | PDBR | CY2010 | PD2010-01268
There was mild social impairment, but no documented occupational impairment. In the matter of the headache and hypertension conditions, or any other medical conditions eligible for Board consideration; the Board unanimously agrees that it cannot recommend any findings of unfit for additional service disability rating. RECOMMENDATION : The Board recommends that the CI’s prior separation be modified to reflect that the CI was placed on the TDRL at 50% for a period of 6 months (PTSD at 50%...
AF | PDBR | CY2011 | PD2011-00563
The examiner stated, “The severity of the patient's condition appears to have been underestimated due to his working in the mental health field and his close proximity to mental health care providers.” In addition to “moderate” bipolar I disorder, the examiner diagnosed ADHD and “anxiety disorder NOS (manifested by combat stress related symptoms not meeting criteria for PTSD and which have gradually improving since his return from combat).” The examiner noted the CI’s psychiatric symptoms...
AF | BCMR | CY2003 | BC-2003-01238
On 5 Feb 01, the Air Force PEB recommended that the applicant be discharged from the Air Force with severance pay with a combined disability rating of 10 percent. The DPPD evaluation is at Exhibit D. _________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: Copies of the Air Force evaluations were forwarded to the applicant on 19 Sep 03 for review and comment within 30 days. It is our opinion that because of the severity of his condition...