IN THE CASE OF: 

		BOARD DATE:	    12 March 2014

		DOCKET NUMBER:  AR20140002392 


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 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 disability and separation determination. 

2.  The SRP considered the appropriateness of changes in the mental health (MH) diagnoses, the physical evaluation board (PEB) fitness determination and, if unfitting, whether the provisions of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 were applicable and a disability rating recommendation in accordance with VASRD Section 4.130. 

3.  The SRP noted the evidence of the available records shows diagnoses of Post-Traumatic Stress Disorder (PTSD), major depressive disorder (MDD), and anxiety disorder not otherwise specified (NOS) were rendered and the diagnoses of PTSD and MDD were eliminated during the applicant's processing through the Integrated Disability Evaluation System (IDES). 

4.  The SRP undertook a careful review of the clinical documents to determine if
a diagnosis of MDD met the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria.  The SRP agreed there was insufficient evidence to support the MDD diagnosis.  The depressive symptoms reported were within the anxiety spectrum conditions and did not confer a separate diagnosis when full DSM-IV diagnostic criteria were not met.  The majority of the treatment notes did not reflect a primary depression condition and depression was not a treatment focus.  

5.  The SRP noted the applicant reported multiple combat-related exposures documented in the commander's statement; therefore, Criterion A of DSM-IV diagnostic criteria for PTSD was met.  However, the full DSM-IV TR diagnostic criteria for PTSD were not met.  There was no evidence of impaired social relationships or avoidance of social activities due to recollection of traumatic experiences.  

6.  The SRP agreed the appropriate diagnosis was anxiety disorder NOS. Therefore, the PEB appropriately did not consider PTSD and depression as the correct diagnoses at the time of the applicant's separation.  The SRP determined the MH diagnoses were appropriately eliminated in the disability evaluation process.  Therefore, the applicant did not appear to meet the inclusion criteria in the Terms of Reference of the Mental Health Diagnosis Review Project. 

7.  The SRP further agreed the PEB adjudication of unfitting anxiety disorder NOS was well supported by the evidence.  Regardless of the final PEB diagnosis, VASRD 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. 

8.  The SRP concluded sufficient evidence supported a highly-stressful event severe enough to bring about the Veteran's release from active military service did occur and that the application of VASRD Section 4.129 by the PEB was appropriate in this case.

9.  The SRP determined the disability associated with all psychiatric conditions, regardless of the diagnosis or multiple diagnoses, were subsumed under a single rating using the same criteria in accordance with VASRD Section 4.130. The applicant's disability rating assigned by the PEB and the recommendation from the SRP would be unaffected by the specific psychiatric diagnosis determined to be unfitting by his service. 

10.  The SRP deliberated if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at the time of the applicant's placement on the Temporary Disability Retired List (TDRL).  It was noted that there were no visits by the applicant to the emergency room for MH treatment, no psychiatric hospitalization, no legal issues or incidents of domestic violence, and no impairment in his thinking.  The absence of any threshold symptoms of the next higher 70 percent rating, for example, recurrent suicidal ideation, special disorientation, obsessional , and neglect of personal appearance and hygiene was also considered. 

11.  The SRP agreed that occupational and social impairment, with deficiencies
in most areas (such as work, school, family relations, judgment, thinking or mood) was not reflected in the evidence, and therefore agreed that a rating higher than 50 percent at the time of placement on TDRL was not supported. 

12.  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 condition.

13.  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)                                  AR20140002392



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