IN THE CASE OF:	

		BOARD DATE:	    5 February 2014

		DOCKET NUMBER:  AR20140000121 


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 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 Department of Defense (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 DOD 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 responded to the advisory opinion and provided 8 exhibits with his rebuttal as follows:

* Health record, dated 11 February 2008, 2 pages
* Health record, dated 10 April 2008, 1 page
* Report of mental status, dated 22 February 2008, 3 pages
* Internet article, Army psychologist reveals instructions to misdiagnose PTSD, 4 pages
* Department of Veterans Affairs (VA)
*  rating decision covering PTSD, dated 25 October 2011, 4 pages
* Memorandum for Record, incomplete medical record, dated 29 September 2010, 1 page
* University of Phoenix Student Audit Report, dated 17 December 2013, 
4 pages
* Enlisted Record Brief, dated 6 April 2010

5.  In his rebuttal, the applicant stated:

   a.  After being medically evacuated from Iraq to Landstuhl, Germany while being examined for a traumatic brain injury, he was also diagnosed as suffering with Post Traumatic Stress Disorder (PTSD).  Afterward, he began to see a psychologist and a psychiatrist.  He noted at that time, the Army was pressuring psychiatrists and psychologists to treat PTSD as an anxiety disorder which occurred in his case.  He further stated the VA gave him a 30 percent service-connected disability rating and that his medical records were incomplete.   

	b.  When he started attending college his grade point average was 4.0; however, shortly afterward it dropped to 2.8 due to many reasons such as inability to find work and suffering from nightmares.  He believed that his PTSD was not taken seriously at the time and that it is subject to interpretation.  He further stated that he served on active duty honorably for 12 years, 10 months, and 6 days.  He did not file an appeal at the time because he felt the system failed him.  His record does not show the stigma that Soldiers face when seeking treatment for PTSD or the nightmares associated with experiencing death on the battlefield or the chain of command berating him for going to therapy.  

	c.  He still has negative altercations mood patterns, persistent negative trauma-related emotions, alienation, and feelings of guilt.  His wife has slept many times in another room due to his kicking and flailing while sleeping, and at times staying up with him for countless hours consoling his restless and sleepless nights.  He understands PTSD symptoms can improve; however he also believes the symptoms can regress without any warning.  

	d.  His PTSD is chronic.  Some days it may not appear while other days it does with distressing dreams that still haunt him.  He feels his commander tried to separate him instead of sending him to treatment and/or having him medically boarded.  He still feels berated because of his many disabilities that started to take a toll on his body.  

6.  In summary, he is requesting reconsideration of the SRP's recommendation so that he can seek the help he needs.

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 separation determination. 

2.  The SRP reviewed the records for evidence of inappropriate changes in the applicant's diagnosis of the mental health (MH) condition during his processing through the Disability Evaluation System (DES).  The available records show that an actual diagnosis of PTSD was rendered first at the medical evaluation board (MEB) on 23 September 2010. 

3.  The SRP noted that at the time of the applicant’s processing through the DES, PTSD was identified by the MEB and the physical evaluation board (PEB) and no adverse change in diagnosis was made at any time.  Therefore, the applicant did not meet the criteria for the Terms of Reference for the MH Review Project. 

4.  The SRP also considered whether the mental conditions, regardless of specific diagnoses, were unfitting for continued military service.

5.  The SRP unanimously agreed that evidence of the record reflected minimal symptoms and reasonably good duty performance (as related to mental functioning) in the period of time leading into the MEB. 

6.  The SRP noted the service treatment records (STR) prior to the MEB examination that referenced or mentioned PTSD were in the context of the applicant’s provided history and not actually diagnosed by a healthcare provider.  The applicant’s record reflected psychiatric diagnoses of anxiety disorder, marital problems, other interpersonal problems and adjustment disorder with depressed and anxious mood…rule out PTSD; the majority of which was related to leadership issues in the workplace and family/financial discord. 
7.  The SRP noted the sole adverse finding of a “frustrated mood” on the MEB did not indicate an MH diagnosis in and of itself and it appeared the chronic PTSD diagnosis was based upon a highly scored PTSD “screening checklist (PCL-M).”  While the applicant was described in the psychiatric MEB as having displayed symptoms that could be associated with PTSD, they also were seen with anxiety and depression; additional screening exams (GAD-7; PHQ-9) did make that association plausible.  Despite the diagnosis, the limited symptomatology did not appear to have interfered significantly with duty or with subsequent occupational functioning; and thus the chronic PTSD was found by the psychiatrist to be not unfitting.

8.  After due deliberation in consideration of the preponderance of the evidence, the SRP concluded that the PEB’s determination that the MH condition was not unfitting at the time of separation and not subject to disability rating was correct.

9.  After careful consideration of the available evidence and the applicant’s response to the advisory opinion, the SRP 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 that 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



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ABCMR Record of Proceedings (cont)                                  AR20140000121



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