IN THE CASE OF:	

		BOARD DATE:	  26 February 2014

		DOCKET NUMBER:  AR20140001264 
	

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 MH diagnosis was changed during that process.

3.  The applicant submitted an application through the Department of Defense (DOD) Physical Disability Board of Review (PDBR) MH 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 an MH 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 MH 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 reviewed the records for evidence of inappropriate changes in diagnosis of the MH condition during processing through the Disability Evaluation System (DES). 

3.  The evidence of the available records show diagnoses of Post-Traumatic Stress Disorder (PTSD), attention deficit hyperactivity disorder (ADHD) and anxiety disorder not otherwise specified (NOS) were recorded on the 2009 and 2010 profiles, a year prior to the medical evaluation board (MEB). 

4.  The diagnoses of PTSD and ADHD were eliminated during processing through the DES.  The applicant, therefore, did appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project. 

5.  The SRP undertook a careful review of the clinical documents to determine if a diagnosis of PTSD met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria.  The psychiatric narrative summary (NARSUM) found no evidence that the applicant met full DSM-IV diagnostic criteria for PTSD. 

6.  The applicant’s treatment record noted persistent complaint of work-related stressors accompanied by anxiety symptoms.  Hospital admission note (October 2010) recorded the complaint of "I started smoking weed and drinking to deal with my anxiety."  She indicated PTSD symptoms were not her issue; "But now there's just a lot of anxiety, not nightmares or flashbacks so much."  

7.  The admission psychiatrist noted the primary focus was anxiety and substance abuse; PTSD was not diagnosed.  Therapy treatment notes did not record a PTSD diagnosis and there was no evidence that PTSD was a focus in treatment.  The treating psychiatrist noted in treatment entry of 25 August 2010, work stressors had been profound but that the applicant continued to do well outside of work and had a supportive social group and that mood/anxiety symptoms were minimal outside of work.
8.  There was no evidence of impaired social relationships, restricted range of affect, inability to recall important aspects of trauma exposure, or avoidance of social activities due to recollection of traumatic experiences. 

9.  The SRP acknowledged the S3 profile for PTSD, ADHD and anxiety disorder dated a year prior to the MEB, and concluded at the time of separation the applicant did not meet criteria for the diagnosis of PTSD.  At the time of separation, there was no evidence that applicant met criterion Band C of DSM-IV TR diagnostic criteria for PTSD. 

10.  The SRP acknowledged the Department of Veterans Affairs (VA) Compensation and Pension (C and P) evaluation, 4 months after separation, that the applicant's reported symptoms met DSM-IV diagnostic criteria for PTSD; however, clinical documentation throughout the record recorded minimal symptoms of PTSD and no indication that PTSD diagnostic criteria were ever met.

11.  The SRP concluded the diagnosis of anxiety disorder NOS was the appropriate diagnosis at the time of separation.  The SRP indicated that regardless of the final physical evaluation board (PEB) diagnosis, Section 4.129 did not specify a diagnosis of PTSD, rather it stated "mental disorder due to a highly stressful event" and its application was not restricted to PTSD. 

12.  The SRP acknowledged a history of combat trauma; however, the applicant was medically and psychiatrically cleared for reactivation after these stressful events.  The applicant’s post-activation records showed evidence of work stress.

13.  The SRP determined that there was not sufficient evidence to support a conclusion that a highly stressful event severe enough to bring about the Veteran's release from active military service occurred and the application of Section 4.129 was not appropriate in this case. 

14.  The SRP considered if there was evidence for Section 4.130 rating higher than 30 percent at the time of medical retirement.  The higher 50 percent rating was for occupational and social impairment with reduced reliability and productivity and symptoms of mental impairment in thinking, judgment, memory, and such as panic attacks. 

15.  The applicant’s NARSUM and C and P examination described moderate symptoms; however, the record noted the applicant had no functional impairment outside of the work environment and that was demonstrated at the C and P examination.  At the C and P exam, there was very little evidence of functional impairment at the moderate level. 
16.  The applicant was working as a substitute teacher for high school and elementary students; typically, a very challenging and anxiety provoking environment.  The treatment record consistently demonstrated essentially normal mental status with the exception of mood and anxiety symptoms that were noted to improve with medication.  The applicant continued to report panic attacks at a frequency of more than once a week; however, there was no recorded impairment in thinking, judgment, memory, and no mood symptoms.  

17.  The applicant sought permanent, full-time employment and completion of her college education.  There were no hospitalizations for mental condition recorded prior to or after retirement; no reported active suicidal ideation (not evident in record; no attempts, no emergency room (ER) visits).

18.  The SRP considered the record in evidence best supported the 30 percent Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.130 rating and there was insufficient reasonable doubt for recommending a 50 percent rating.

19.  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 adjudication for the applicant's MH conditions.

20.  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 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)                                  AR20140001264



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