IN THE CASE OF:	

		BOARD DATE:	  23 April 2014

		DOCKET NUMBER:  AR20140004230 


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 a 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 to the physical evaluation board (PEB)’s determination that an adjustment disorder was the correct diagnosis and that it was not compensable; and concluded that there should be no change to the applicant’s disability retirement determination.

2.  The SRP reviewed the records for evidence of inappropriate changes in diagnosis of the MH condition during processing through the military disability evaluation system (DES).  The available records show diagnoses of adjustment disorder (with mixed anxiety and depressive mood) and Post-Traumatic Stress Disorder (PTSD).  However the PTSD diagnosis, which was on the permanent profile, the medical evaluation board (MEB) submission, and the initial PEB form was changed by the informal PEB to an adjustment disorder.  The SRP concluded the MH diagnosis was changed in the DES process.  Therefore, the applicant met the inclusion criteria in the Terms of Reference of the MH Diagnosis Review Project.

3.  The SRP considered the criteria for diagnosis according to the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), Text Revision (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), presence of clinically significant distress or impairment in social, occupation or other important area of functioning (criterion F).

4.  The SRP noted that although the applicant reported some symptoms commonly associated with PTSD, the clinical evidence in this case did not support a diagnosis of PTSD.  Criterion A was partially met, and criterion C was not met; therefore, the applicant did not fully meet DSM-IV TR diagnostic criteria for PTSD.  The SRP agreed, the constellation of symptoms reported was best reflected in the diagnosis of an adjustment disorder; therefore, the diagnosis of adjustment disorder with mixed anxiety and depression was the most appropriate diagnosis at the time of the applicant’s Temporary Disability Retired List (TDRL) entry.


5.  The SRP also considered whether any mental condition was unfitting for continued military service.  As reflected in the PEB's final determination, an adjustment disorder with mixed anxiety and depressed mood was not a physical disability and was not ratable in accordance with Department of Defense Instruction (DoDI) 1332.38.  The SRP's threshold for recommending a not-unfit determination required a preponderance of the evidence.

6.  The SRP agreed that regardless of specific diagnosis, evidence of the record reflected minimal occupational impairment on the basis of MH related symptoms.  Although the commander's statement indicated that the applicant's physical and mental condition interfered with his military occupational specialist duties and he had a S4 profile for PTSD there was no indication from the record that the MH condition significantly interfered with satisfactory duty performance. 

7.   The SRP formally recommended that the diagnosis Axis I PTSD be added to the initial TDRL entry.  However the member's PTSD diagnosis did not rise to the level of unfitting and the diagnosis of an adjustment disorder better reflected the accurate diagnosis at the time of the applicant’s TDRL exit which was not a compensable condition which was adjudicated by the PEB.

8.  The SRP noted the evidence indicated the applicant never had any loss of duty time due to his MH condition.  There were no recorded emergency room visits or psychiatric hospitalizations and after separation the applicant was employed as a police officer and did not require psychiatric management of any MH condition.  The SRP concluded that there was insufficient evidence that any MH condition rose to the level of being unfitting at the time of separation.

9.  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 fitness determination for the MH condition and therefore no disability ratings were recommended.  

10.  The available evidence shows the SRP’s assessment should be accepted.  

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

___X____  ___X____  ____X___  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION
BOARD DETERMINATION/RECOMMENDATION:

1.  The Board determined that the evidence presented was sufficient to warrant a recommendation for partial relief.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by adding the diagnosis of Axis I PTSD at the initial TDRL entry.

2.  The Board further determined that the evidence presented was insufficient to warrant a portion of the requested relief.  As a result, the Board recommends denial of so much of the application that pertains to showing that any change was made to the PEB's determination that adjustment disorder was the correct diagnosis and that it was not compensable at the time of his TDRL exit.



      __________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)                                  AR20140004230



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