BOARD DATE:	  16 April 2014

		DOCKET NUMBER:  AR20140004114 


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 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 the diagnosis of the Mental Health condition during processing through the Disability Evaluation System (DES).  The available records revealed that the diagnosis of Post-Traumatic Stress Disorder (PTSD) was first identified in July 2010 and was the primary mental health diagnosis referred to the DES and remained unchanged throughout processing through the DES.  Therefore, the applicant did not meet the criteria of the Terms of Reference for the Mental Health Review Project.  

3.  The SRP noted that the Physical Evaluation Board (PEB) applied the presumption of fitness provision of DOD Instruction (DODI) 1332.38 (paragraph E3.P3.5).  The dictation of the Medical Evaluation Board (MEB) occurred after the request for voluntary retirement was approved and the applicant was presumed fit.  The applicant’s retirement application was approved on 21 July 2010 and she was not referred into the DES until after this date.  Her 2010 draft Narrative Summary (NARSUM) indicated intent for referral.  However, the official MEB NARSUM was dated 18 May 2011 which was considered the date for entry into the DES according to DODI 1332.38 paragraph E3.P3.5.2.  In either instance, the applicant was in the presumptive period prior to referral into the DES and the presumption of fitness rule applied.

4.  The SRP considered whether the evidence regarding the mental health conditions overcame the presumption of fitness.  For the presumption of fitness to be overcome, there must be an acute, grave illness or injury that would prevent the member from performing further duty if he or she were not retiring.  The presumption of fitness may also be overcome when there is a serious deterioration of a previously diagnosed condition that would preclude further duty if the member was not retiring.  When there was no serious deterioration within the presumptive period, the ability to perform duty in the future shall not be a consideration. 


5.  The SRP noted that if a preponderance of evidence demonstrated that the member was not satisfactorily performing the duties befitting their grade and experience prior to entering the presumptive period, then the presumption of fitness was overcome. 

6.  The SRP considered DODI 1332.38 paragraph E3.P3.3.4. Cause and Effect Relationship in its deliberations which stated that "…..inadequate performance of duty, by itself, shall not be considered as evidence of unfitness due to physical disability unless it is established that there is a cause  and effect  relationship between the two factors."  In this case there was not an acute, grave illness or injury and the evidence clearly indicated the applicant was satisfactorily performing her duties prior to approval of her request for voluntary length of service retirement.  The applicant had longstanding chronic conditions including her mental conditions that appeared to worsen after entering the presumptive period. 

7.  The SRP considered whether the worsening of the applicant's mental health conditions during the presumptive period overcame the presumption of fitness.  The MEB NARSUM and treatment records leading into the MEB documented mental health symptoms diagnosed as PTSD and depression for approximately 
8 years before the applicant's referral for an MEB.   Service treatment records also documented a history of depression over 10 years before referral for an MEB.  Despite these chronic symptoms, the applicant performed her duties well.  Her symptoms were reported to worsen for which she sought care closely preceding the time her unit deployed. 

8.  The SRP noted that the applicant's commander (apparently not her original commander) did not recommend retention on active duty, and noted a change in motivation and attitude as the applicant proceeded through the MEB process. However all SRP members agreed that evidence of the record reflected mild to moderate symptoms in the period of time leading into the MEB.  In deliberation, the SRP also noted that the majority of psychiatry notes endorsed either anxiety disorder or insomnia neither of which required profiling.  Additionally, the majority of psychology notes endorsed chronic PTSD also not requiring a profile.  Although the MEB determined the PTSD condition did not meet retention standards, they also indicated and described only "some" impairment in social and occupational functioning with "occasional" decrease in work efficiency, and "generally functioning satisfactory." 



9.  After due deliberation in consideration of the preponderance of the evidence, the SRP concluded that the evidence regarding the mental health conditions did not overcome the presumption of fitness.

10.  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)                                  AR20140004114



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