IN THE CASE OF:	  

		BOARD DATE:	  31 October 2013

		DOCKET NUMBER:  AR20120018620 


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 of his mental health condition.  

2.  The applicant states his original medical evaluation board (MEB) stated that he had Adjustment Disorder with mixed anxiety and depressed mood that was medically acceptable.  He was reexamined and he was diagnosed with Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD), not an adjustment disorder.  In accordance with a 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 diagnoses were changed during that process, his case file should be reviewed.

3.  The applicant submitted an application to the DOD Physical Disability Board of Review (PBDR) Mental Health Special Review Panel (SRP) with attachments, including a Department of Veterans Affairs (VA) Form 3288 (Request for and Consent to Release of Information from Individual's Records). 

CONSIDERATION OF EVIDENCE:

1.  The applicant's records show he enlisted in the Regular Army (RA) on 23 June 2005 and he held military occupational specialty (MOS) 92G (Food Service Operations Specialist).  He was honorably discharged on 5 October 2008.

2.  He again enlisted in the RA on 15 October 2008 and he reenlisted on 4 February 2010.  He served in Afghanistan from 12 December 2009 to 
13 December 2010. 

3.  On 22 December 2011, after having complained of low back pain, an MEB convened and, after consideration of clinical records, laboratory findings, and physical examinations, the MEB found the applicant was diagnosed with the below conditions.  The MEB recommended the applicant's referral to a physical evaluation board (PEB).  He was counseled and agreed with the MEB's findings and recommendation.  

Diagnosis
Met Retention Standards
Did Not Meet Retention Standards
1.  Lumbosacral pain

X
2.  Impingement syndrome, right shoulder
X

3.  Strain, left shoulder 
X

4.  Hypertension
X

5.  External hemorrhoids
X

6.  Bilateral plantar fasciitis
X

7.  Sleep apnea
X

8.  Cervical strain, mild
X

9.  Adjustment Disorder with mixed anxiety and depressed mood
X

10.  Occupational problems
X

11.  Bilateral persistent tinnitus
X

4.  On 17 February 2013, an informal PEB convened and reviewed the medical data and other facts presented to include the commander's statement.  The PEB found the applicant's condition prevented him from performing the duties required of his grade and military specialty and determined that the applicant was physically unfit due to lumbosacral pain.  

	a.  The PEB noted that he reported a long history of back pain due to running and physical fitness training that was neither a battle injury nor occurred in combat theater.  The condition was unfitting because of his inability to lift/carry more than 35 pounds, his inability to stand for prolonged periods of time, and his inability to wear protective gear.  The PEB rated the applicant's medically-

unacceptable condition under the VA Schedule for Rating Disabilities (VASRD) as follows: 

VASRD Code
Condition 
Percentage
5237
Lumbosacral strain
20%
	b.  The PEB also considered his other medical conditions but found these conditions not to be unfitting and therefore not ratable.  The PEB recommended a 20% combined disability rating and separation with entitlement to severance pay if otherwise qualified.  Subsequent to counseling, the applicant concurred with the PEB's finding and recommendation and waived his right to a formal hearing.

5.  The applicant was discharged on 15 March 2012 in accordance with Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation), paragraph 4-24b(3) with entitlement to severance pay.  

6.  On 9 August 2012, Dr. E. C. H-------n, a civilian psychiatrist, conducted a cell reevaluation of the applicant's behavioral health to assess his current psychiatric fitness for duty following a previous evaluation in which a forensic behavioral health evaluation was conducted.  Dr. E. C. H-------n proposed:

* the deletion of "Adjustment Disorder with Mixed Anxiety and depressed Mood; Meets retention standards" and "Occupational problems; Meets retention standards"
* the addition of "Major Depressive Disorder, single episode, moderate, Fails retention standards" and "PTSD, Chronic, Fails retention standards"

7.  Dr. E. C. H-------n provided an MEB Addendum that shows the applicant's behavioral health diagnosis as follows:

* Axis I: Major Depressive Disorder, Single Episode, Moderate; PTSD, Chronic; Alcohol Abuse
* Axis II: No diagnosis
* Axis III: Chronic pain secondary to lumbar disc disease, bilateral shoulder pain and plantar fasciitis; hypertension; hemorrhoids
* Axis IV: Occupational, primary support
* Axis V: Periodic suicidal ideation; Global Assessment of Functioning (GAF) score of 48

8.  An advisory opinion was obtained on 28 December 2012 from the U.S. Army Physical Disability Agency (USAPDA) in the processing of this case.  An official of the USAPDA stated:  

	a.  The applicant requests that his military records be corrected to reflect that he was unfit for the condition of PTSD instead of adjustment disorder and that his separation with severance pay be changed to disability retirement.  The applicant cites as evidence for the correction a new post-separation psychiatric opinion rendered on 9 August 2012.  
	b.  The applicant's MEB was completed on 22 November 2011.  It listed adjustment disorder with mixed anxiety and depressed mood as the sole mental health diagnosis recognized by the military and that it met medical retention standards.  Adjustment disorders are not considered compensable disabilities in accordance with DODI 1332.38.  The MEB included a 10 page forensic psychiatric report by Dr. Th-----n.  The report was based on an extensive personal interview with the applicant and a review of all of his mental health records; to include those proffered by the VA.  The report noted that the military mental health providers had originally diagnosed the applicant with adjustment disorder with anxiety and depressed mood in 2010.  It was noted the past military mental health providers indicated that PTSD had been considered, but that he did not appear to meet the criteria for PTSD.  In September 2011 he was diagnosed with PTSD, but the MEB noted that the "PTSD appears to have been diagnosed based on his scores of testing measures alone."  After fully considering all of the evidence, to include the examination results, the MEB held that the applicant did not meet the full criteria for PTSD and that the diagnosis of Adjustment Disorder would continue to be listed as the applicant's sole psychiatric diagnosis.  The MEB went on to note that the applicant's reported symptoms at that time (no matter what the ultimate diagnosis was) did "not appear to have had a significant impact on his ability to perform military duties."  These findings were reviewed by three physicians, to include a psychiatrist, and reviewed and approved by another physician (the MEB approving authority).  Upon review of the MEB findings, the applicant concurred with those findings.

	c.  An informal PEB found the applicant unfit for his condition of lumbosacral strain and awarded 20 percent disability compensation and separation with severance pay.  After reviewing the PEB findings and being counseled on his rights, the applicant concurred with the PEB findings and waived his right to a formal hearing.

	d.  On 9 Aug 2012, a new psychiatric opinion was provided by Dr. E. C.        H-------n.  In a 19-page report Dr. E. C. H-------n  opined that the previous findings 

of the MEB regarding the mental health diagnosis of the applicant was not correct in that in her opinion the applicant did have PTSD at the time of his MEB/PEB and it did not meet medical retention standards in accordance with chapter 3, Army Regulation 40-501 (Standards of Medical Fitness).  This new report was based on an interview with the applicant in August 2012 (5 months after the applicant's separation from the military) and the applicant's entire past mental health records.  The new report opined that the MEB findings were not supported by the evidence and that the applicant did meet the criteria for the diagnosis of PTSD.  A review of the evidence provided with this new report does not indicate if it was ever reviewed and approved by any other physicians or that it was processed in accordance with Chapter 7, Army Regulation 40-400 (Patient Administration), MEB requirements.

	e.  A review of all of the evidence in the applicant's case file does not provide a preponderance of the evidence that this new post-separation opinion outweighs all of the evidence that was extensively reviewed and approved by numerous physicians at the time the applicant was in the military, which the applicant reviewed and concurred in at the time. In reviewing the totality of the evidence, this Agency does not find that the August 2012 opinion requires changes to the original findings of the MEB/PEB proceedings; makes the MEB/PEB findings to be no longer supported by a preponderance of the evidence; or makes the previous findings arbitrary or capricious.  Even if the diagnosis had been PTSD the preponderance of the evidence existing at the time that the Soldier was going through the MEB/PEB process indicates that the applicant's description of his symptoms, at that time, did not rise to a level that made any mental health diagnosis to not meet medical retention standards.  Therefore no matter the diagnosis the applicant would not have been found unfit for the mental health condition.  Even though the new mental health review was accomplished within 5 months of the applicant's separation from the military, it was still accomplished almost a year after the MEB findings and it is not unusual for mental health conditions to change and progress with time and after changes to an individual's social and employment circumstances.

	f.  If, after review of all of the evidence in the case file, the Board is of the opinion that the August 2012 opinion overcomes all of the other evidence on which the MEB/PEB findings were based, relating to the mental health diagnoses and findings, then the Board has the authority to change the applicant's military records to reflect that he would have been found unfit for PTSD when he separated from the military in March 2012.  If unfit for a compensable condition, the applicant's disability compensation would have been at 30% as noted on the 28 December 2011 VA rating that would have had to have been used in the IDES process.  This would have been increased to 50 percent in accordance with VASRD 4.129 and the applicant would have had to have been placed on the Temporary Disability Retired List (TDRL) at a total rating of 60 percent.

9.  The applicant was provided with a copy of this advisory opinion but he did not respond. 

10.  On 18 April 2013, the Army Review Boards Agency notified the applicant that on 27 February 2013, the Under Secretary of Defense directed the military services to conduct a comprehensive review of service members who completed a disability evaluation process and whose mental health diagnoses were changed to their possible disadvantage during the process.  The Under Secretary directed this review be conducted by the PDBR who will in turn provide an advisory opinion to the appropriate Board of Correction for appropriate action.  The applicant's case met the criteria above.  As a result, the PDBR would consider all the documentation he previously provided and will also consider his VA records, with his consent, before providing an advisory opinion. 

11.  On 14 May 2013, the applicant completed a VA Form 3288 authorizing the release of information from his records for consideration by the PDBR Mental Health SRP.

12.  The PDBR SRP conducted a comprehensive review of the applicant's records for evidence of inappropriate changes in the diagnosis of his mental health condition during processing through the military disability system.  The SRP finding, dated 16 October 2013, recommended by a vote of 2 (majority) to    1 (minority) the applicant's unfitting condition diagnosis be changed to PTSD/Major Depressive Disorder, and that his prior separation be modified to reflect he was placed on the TDRL with a combined rating of 60% for a period of 6 months (PTSD at minimum 50% in accordance with section 4.129 and DOD directive) and then permanent combined disability retirement also at 60%.  The majority recommended:

Unfitting Condition
VASRD Code
TDRL Rating
Permanent Rating 
PTSD/Major Depressive Disorder
9411/9440
50%
50%
Chronic Low Back Pain
5237
20%
20%
Combined rating

60%
60%

13.  The majority of the SRP Panel members opined that: 

	a. The SRP considered the appropriateness of changes in mental health diagnoses, PEB fitness determination; and if unfitting, whether the provisions of VASRD §4.129 were applicable, and a disability rating recommendation in accordance with VASRD §4.130.  The Panel considered the criteria for diagnosis according to the Diagnostic and Statistical Manual for Mental Disorders IV (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 Panel first addressed the question of the mental health condition diagnosis.  Since the IDES VA exam diagnoses of PTSD and MDD were eliminated in the course of the IDES process (as well as nightmare disorder) the SRP concluded that the case met the inclusion criteria in the Terms of Reference of the Mental Health Diagnosis Review Project.

	b.  The SRP next deliberated on the appropriateness of a diagnosis of PTSD and/or MDD.  Panel members noted that several of the applicant's providers had considered that diagnosis following his return from deployment.  He had, in fact, qualified for the Prazosin nightmare study for which one of the prerequisites was the presence of nightmares related to combat stress.  Notes from that program document a diagnosis of PTSD.  While some providers had opined that there was no "index trauma" reported by the applicant as having occurred while he was deployed, several of the events he encountered during the year-long deployment in Afghanistan could have qualified alone and in the aggregate as sufficiently stressful to the applicant to fulfill Criterion A of the PTSD diagnosis.  The fulfillment of this criterion is alluded to in various places in the record and quite succinctly by the psychiatrist in her report.  This conclusion is further supported by the VA Compensation and Pension (C&P) examination and documented elsewhere in the record. The fulfillment of the other DSM-IV criteria for the PTSD diagnosis are clearly enunciated by both the C&P evaluation performed 6 months prior to separation and the psychiatrist's report 5 months after separation. Psychometric testing, done as part of the forensic evaluation, indicates that the results are consistent with a number of psychiatric disorders including PTSD and that while there may have been some over-reporting of symptoms the results remained valid.  The psychiatric exam and assessment from the psychiatrist was much more comprehensive, detailed, and better supported by the record of evidence than the Memorandum of Diagnostic Variance.

	c.  Independent SRP psychiatrist evaluation of the entirety of record indicated that the preponderance of the evidence favors the diagnoses of PTSD and MDD at the time of separation.  The majority of Panel members agreed that the preponderance of the evidence supported diagnoses of PTSD and MDD at the time of separation.  

	d.  The Panel next addressed the question of fitness with regard to the mental health conditions.  It considered the commander's statement which, although addressing primarily physical limitations, indicated that the applicant was having difficulty establishing and maintaining effective work relationships, had "anger issues" (hand-written) and that PTSD was part of the applicant's permanent profile (hand-written).  It also noted that the statement indicated the commander had not directly observed that behavior.  There is also no indication in the available record that the applicant was ever issued other than an S1 profile aside from the commander's note on the DA Form 7652.  Of note is that there was only one DA Form 3349 in the record, dated 8 November 2011 (the date of the NARSUM) listing "Chronic low back pain, Sleep apnea" P2L3S1.  Lack of a psychiatric profile was clearly stated in the forensic note, the Memorandum of Diagnostic Variance and the USAPDA response concurring with the PEB adjudication.  The applicant's 30 November 2011 letter to the MEB appeared to cite his pain and physical disability as his reason for desiring medical retirement as well as requesting addition of his shoulders and feet conditions as not being fit for duty, without mentioning any other mental health related symptoms. 

	e.  However, the applicant did manifest impairment in his ability to adapt to stressors in the workplace as evidenced throughout the treatment record by his difficulties adapting to the new unit after changing station to Fort Lewis, WA.  A note from a psychiatrist in December 2011 states the "SM [Service member] IS NOT cleared for WWD [World Wide Deployment].  SM CANNOT be expected to perform duties in austere and harsh environments with little or no mental health services.  IS NOT cleared for deployment from a mental health perspective." Irritability is also well-documented in the record and in May 2011 one of his providers stated that she thought “…he might be eligible for board, appears to have a history of untreated issues that have become worse.  This writer worries about potential of SM's actions if he isn't successful getting out of the Army."  A November 2011 clinical note describes the applicant as "irritable all the time" with anger outbursts once per week.  Such symptoms suggest that, had they been required to make such a determination, the applicant's providers would have restricted his clearance to carry a weapon and, in fact, shortly after separation, the applicant's VA provider convinced him to dispose of the firearm he owned.

	f.  Given the consistency of the reporting of such symptoms and the commander's comments, a majority of SRP members concurred with the opinion of the psychiatrist who felt that the preponderance of the evidence suggested a significant impact of the condition on occupational functioning, that the applicant should have been issued a permanent S3 profile and that symptoms were to the level of being unfitting.  The majority of the SRP determined that there was a preponderance of evidence indicating that interference in occupational functioning due to PTSD and MDD symptoms rose to the level of being unfitting at the time of separation.  

	g.  Office of the Under Secretary of Defense memorandum, dated 17 July 2009 states: "Therefore, as a matter of policy, the PDBR and all three BCMRs will apply VASRD Section 4.129 to PTSD unfitting conditions for applicants discharged after 11 September 2001, and in such cases, where a grant of relief is appropriate, assign a disability rating of not less than 50% for PTSD unfitting conditions for an initial period of 6 months following separation, with subsequent fitness and PTSD ratings based on the applicable evidence."  A majority of SRP members agreed that there was not sufficient evidence for a VASRD §4.130 rating higher than 50% at the time of placement on constructive TDRL.

	h.  The most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case is the Psychiatric Addendum to the MEB written on 9 August 2012, 5 months following separation.  That note indicates continued significant impairment in functioning.  At that time, the applicant had only one friend, had no desire or motivation to make any new friends, and had difficulty when he tried to do so.  He complained of problems with memory and concentration.  His symptoms of anxiety and irritability increased when he left his house for errands and he continued to experience tearful spells.  Mood was depressed on a daily basis and he was unmotivated and unable to progress with vocational goals.  He had been unable to seek employment despite a desire to do so and he was unable to participate in any schooling.  GAF of 48 was in the range of serious symptoms.

	i.  The Panel deliberated if the record supported a permanent 30% or 50% rating recommendation in accordance with (lAW) VASRD §4.130 when considering the co-morbid PTSD and MDD symptoms.  The assigned GAF was lower than what might be supported by the documented history and the mental status exam; however, there was sufficient description of symptoms to indicate that occupational and social impairment was not occasional with generally satisfactory functioning (30% criteria).  The daily depressed mood and inability to progress with vocational goal supported the 50% rating criteria of "occupational 

and social impairment with reduced reliability and productivity."  Ideally, there would have been a longer TDRL timeframe to indicate whether the stresses of recent separation from the service contributed to the applicant's impairment, but there was no data beyond the 5-month post-separation timeframe and potential improvement following the 6-month retroactive TDRL timeframe is unduly speculative.  The SRP by a vote of 2:1 concluded that this level of functioning was consistent with a disability rating of 50% lAW VASRD §4.130.  The single voter for dissent (who recommended no re-characterization) submitted the appended minority opinion.

14.  The minority opinion of the SRP Panel stated the overall facts of the case are presented in the majority advisory.  The crux of this case and the foundation for the majority advisory hinges on the VA exam conducted during the IDES process, the applicant's admittance into a medical study, STR records, and the psychiatric evaluation conducted 5 months after separation.  Based on those four factors, the majority concluded that the applicant had PTSD at separation, and that it was unfitting. The minority member does not agree that the applicant had PTSD at separation for the following reasons:  

	a.  The VA exam was conducted by a psychologist and not reviewed by a psychiatrist; the Army conducted two reviews of the VA exam, the first by a psychologist who diagnosed adjustment disorder with mixed anxiety and depressed mood and the second by a psychiatrist who wrote a memo of diagnostic variance with an Axis I diagnosis of adjustment disorder.  The study that the applicant participated in was for PTSD and depression.  There is no definitive explanation provided as to which condition was the trigger for his inclusion.  While there are many entries that mention PTSD, that diagnosis was never formally made by an Army psychiatrist during the IDES process.  The psychiatric analysis conducted 5 months after separation indicated that MDD and PTSD are "co-morbid and appear to have arisen at about the same time."  This would indicate during deployment, and therefore could be considered a forensic analysis, something the Army is/was attempting to avoid.  The NARSUM indicated adjustment disorder with mixed anxiety and depressed mood, as meeting retention standards and the only profile evident in the record indicated an S1.  The WTU Commander's comments indicated PTSD and anger (hand-written), but also stated that he had not observed the applicant, making his comments third-party, and in the minority member’s view, very questionable.  

	b.  The USAPDA review and response indicates that the adjustment disorder with mixed anxiety and depressed mood is the sole mental health diagnosis recognized by the military.  Additionally, review of the majority advisory opinion 

indicates that the post-separation psychiatric review was used to place the applicant on the TDRL at separation and subsequently remove him from the TDRL 6 months later.  Finally, many of the applicant's comments indicate that the majority of his problems were based on the problems he was having with his wife, whom he divorced immediately after return from overseas.  

	c.  Based on an entire review of the file, the minority voter did not believe enough evidence existed to overturn the ruling of the PEB and the USAPDA's review requested by the Board.  There were a number of conflicting professional opinions and diagnoses that made this case very difficult to adjudicate.  One could easily review the data and come to the conclusion that the applicant did have PTSD at separation; however, given all of the conflicting professional opinions, and the fact that PTSD was never formally diagnosed by an Army psychiatrist prior to separation, the minority voter opines that the PEB adjudicated the correct diagnosis.

	d.  The Panel member submits that the ABCMR consider a minority recommendation that there be no re-characterization of the applicant's disability rating.  The minority voter therefore recommends that there be no re-characterization of the applicant's disability and separation determination, as follows:  

Unfitting Condition
VASRD Code
Rating 
Lumbosacral Strain
5237
20%
Combined Rating

20%
15.  The applicant submitted a rebuttal on 23 October 2013.  He disagreed with the decision and stated:

* he was awarded the Combat Action Badge and he was exposed to constant small arms and rocket fire
* he was involved in over 20 ambush attacks on convoy and witnessed multiple explosions, blasts, and attacks
* he was aware of 13 Soldiers killed plus several others wounded; everyday of his life was in danger
* he was informed by a major to see the psychiatrist 4 months after his medical discharge because the psychiatrist at Fort Lewis did not give the proper diagnosis for PTSD
* he has numerous files documenting his nightmare sleep study for 5 months
* 
he received social security last month and he is scheduled for another appointment; he cannot work ever again
* he questions why he gets medication for a behavioral issue if he does not have PTSD

16.  Memorandum, dated 16 April 2013, Subject: Madigan Fusion Cell Cases, was initiated by the Deputy Surgeon General, Office of the Surgeon General, in support of the Soldiers reevaluated by the Madigan Fusion Cell: 

	a.  From 2007 to 2012, Soldiers undergoing an MEB at Joint Base Lewis- McChord underwent a forensic psychiatric evaluation instead of the standard clinical psychiatric evaluation.  However, clinical, not forensic, evaluations are the only recognized type of assessments for routine Integrated Disability Evaluation System cases.  The use of forensic evaluations was not consistent with the processes in place at all other military treatment facilities. On 7 February 2012, The Surgeon General suspended the use of forensic evaluations during the conduct of MEBs. 

	b.  In early 2012, The Surgeon General directed the establishment of a Fusion Cell under the mission command of Western Regional Medical Command to conduct behavioral health clinical reevaluations and begin a redress process for any Soldiers and former service members who may have been disadvantaged by the Madigan Army Medical Center MEB Forensic Psychiatry Service's practices.   
17.  Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) establishes the Army Physical Disability Evaluation System (PDES) and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his or her office, grade, rank, or rating.  Only the unfitting conditions or defects and those which contribute to unfitness will be considered in arriving at the rated degree of incapacity warranting retirement or separation for disability.  

   a.  Paragraph 3–9 provides guidance for TDRL.  Specifically, it states the TDRL is used in the nature of a "pending list."  It provides a safeguard for the Government against permanently retiring a Soldier who can later fully recover or nearly recover from the disability causing him or her to be unfit.  Conversely, the TDRL safeguards the Soldier from being permanently retired with a condition that may reasonably be expected to develop into a more serious permanent disability. Requirements for placement on the TDRL are the same as for permanent retirement.  The Soldier must be unfit to perform the duties of his or her office, grade, rank, or rating at the time of evaluation.  

   b.  Paragraph 4-17 provides guidance for PEBs.  Specifically, it states PEBs are established to evaluate all cases of physical disability equitably for the Soldier and the Army.  The PEB is not a statutory board.  Its findings and recommendation may be revised.

18.  Army Regulation 40-501 governs medical fitness standards for enlistment; induction; appointment, including officer procurement programs; retention; and separation, including retirement.  Once a determination of physical unfitness is made, the PEB rates all disabilities using the VASRD. 

DISCUSSION AND CONCLUSIONS:

1.  The applicant was considered by an MEB in December 2011 that referred him to a PEB.  His MEB listed one condition - lumbosacral pain - that failed retention standards and several other conditions that met retention standards.  

2.  The PEB found this condition prevented him from performing the duties required of his grade and military specialty and determined he was physically unfit.  The PEB rated him at a combined rating of 20% for lumbosacral pain.  The PEB also considered his other conditions but since those conditions did not fail retention standards and/or were not unfitting, they were not ratable.  The PEB recommended separation with entitlement to severance pay at the rate of 20%.  Subsequent to his counseling, he concurred with the PEB's finding and recommendation and waived his right to a formal hearing.  He was discharged on 15 March 2012.

3.  The PDBR SRP reviewed his case and based on that review recommended, by a vote of 2 to 1, a change of the applicant's disability and separation determination.  The SRP recommended a finding of unfitness and a rating for PTSD as well as a final disposition of the applicant's case.  The majority SRP finding is accepted.

BOARD VOTE:

___x____  ____x___  ___x____  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The Board determined that the evidence presented was sufficient to warrant a recommendation for relief.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected:

	a.  by finding the PEB made a determination of unfitness for PTSD (change from not unfitting PEB diagnosis of anxiety), and that his prior separation be modified to reflect that the applicant was placed on the TDRL at 60% for a period of six months (PTSD at minimum 50% IAW 4.129 and DOD directive) and then permanently retired by reason of physical disability with a final 60% rating as indicated below:	

Unfitting Condition
VASRD Code
TDRL Rating
Permanent Rating 
PTSD/Major Depressive Disorder
9411/9440
50%
50%
Chronic Low Back Pain
5237
20%
20%
Combined rating

60%
60%
	b.  providing orders showing the individual was placed on the TDRL  effective the date of the original medical separation for disability.

	c.  providing orders showing the individual's final disposition was permanent disability retirement.



	d.  amending the applicant’s pay to show the appropriate retired pay in lieu of severance pay.



      __________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)                                         AR20120018620





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ABCMR Record of Proceedings (cont)                                         AR20120018620



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