IN THE CASE OF:	  

		BOARD DATE:	  28 May 2014

		DOCKET NUMBER:  AR20140006934 


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 the applicant’s prior determination should be modified to reflect that the major depressive disorder (MDD) with comorbid generalized anxiety disorder condition was rated at 50 percent rather than 30 percent as of the date of her prior medical separation.

2.  The SRP considered the appropriateness of changes (if any) in MH diagnoses, and provided remedial recommendations if it was judged that there were any eliminations or unfavorable changes in an MH diagnosis by the Service.  The SRP further considered whether the provisions of the Department of Veterans Affair Schedule for Rating Disabilities (VASRD) Section 4.129 were applicable to any unfitting MH condition (physical evaluation board (PEB) adjudicated or SRP recommended), and made rating recommendations in accordance with VASRD Section 4.130 (and VASRD Section 4.129 as appropriate).  

3.  The SRP, under the Terms of Reference of the Mental Health Diagnosis Review Project, considered the elimination or change in a diagnosis of Post-Traumatic Stress Disorder (PTSD) applying criteria of the Diagnostic and Statistical Manual for Mental Disorders IV - Text Revision (DSM IV-TR): 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), and presence of significant distress or impairment in social, occupational or other important area of functioning (criterion F).

4.  The SRP first considered if the Service diagnosis of MDD with comorbid generalized anxiety disorder constituted an unfavorable change in a diagnosis or elimination of the diagnosis of PTSD.  The Service evidence made clear that a diagnosis of PTSD was considered, and the medical evaluation board (MEB) psychiatrist conceded the incarceration stressor as satisfying Criterion A, but judged that most other criteria were not satisfied.  The pre-separation VA psychiatrist, even conceding the alleged sexual abuse, did not find support for a diagnosis of PTSD.  The post-separation VA diagnosis of PTSD relied exclusively on the alleged sexual abuse stressors, and the applicant denied any link of her symptoms with any other stressors at that time (albeit contending a link with the incarceration stressors at the time of this application).

5.  The SRP agreed that a Criterion A stressor, given the contradictory and uncorroborated evidence, was not satisfactorily linked with the MH condition; furthermore, the additional DSM IV-TR criteria could only be partially supported even if Criterion A was conceded.  Therefore, the Service diagnosis of MDD with generalized anxiety disorder was judged by the SRP to be fair and appropriate.  Therefore, the applicant’s case did not appear to meet the inclusion criteria in the Terms of Reference of the Mental Health Diagnosis Review Project.

6.  The SRP next addressed the application of VASRD Section 4.129 in its recommendations; noting that independently of the accepted Temporary Disability Retired List (TDRL) diagnosis of anxiety disorder, VASRD Section 4.129 did not specify a diagnosis of PTSD, rather it stated "mental disorder due to a highly stressful event."  As per the preceding discussion, the only candidates for “highly stressful event” in this case were the incarceration and the alleged sexual abuse.  The 2+ year period of MH stability between the incarceration and the escalation of MH symptoms argued against a significant etiologic role of the former with the latter, and there was a compelling argument against service-connection even if the incarceration was invoked as the VASRD Section 4.129 link.  The role of the alleged sexual abuse did not satisfy a preponderance of evidence standard for invoking it as a link to VASRD Section 4.129.  It was clear that domestic turmoil and MEB stressors made significant and arguably dominant contributions to the evolution of the chronic MH condition, and the SRP agreed that the provisions of VASRD Section 4.129 were not satisfactorily supported in this case.

7.  After arriving at the above-described conclusions, the SRP  turned to assessing the fairness of the separation rating for the MDD/anxiety disorder diagnosis.  The SRP agreed that VASRD Section 4.130 criteria for a 100 percent rating were not met, and considered the 70 percent criteria, i.e., "occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood"; referencing typical symptoms of suicidal ideation, obsessional rituals, illogical speech, near continuous panic or depression, spatial disorientation, neglect of hygiene, and inability to establish relationships.

8.  The SRP noted the evidence provided support for deficiencies across the specified major areas and that it was inconsistent and at times conflicting (example: commander's statement).  The SRP also agreed that support for a 

70 percent recommendation was mitigated by the lack of requirement for inpatient care, the absence of significant suicidal ideation or psychotic features, and the paucity of features as exampled in the VASRD Section 4.130 description.  The SRP thus agreed that a 70 percent recommendation could not be supported, and deliberations turned to a 50 percent recommendation (occupational and social impairment with reduced reliability and productivity) versus the 30% rating (occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks). 

9.  The SRP noted that both the MEB and pre-separation VA psychiatrists documented MH cognitive sequelae that would well support a conclusion that reduced occupational reliability and productivity were inevitable, despite the commander's (unobserved) impression to the contrary.  The occasional decrease in work efficiency inherent in a 30 percent rating would be a fairly speculative assertion.  

10.  After due deliberation in consideration of the preponderance of the evidence, the SRP concluded, mindful of VASRD Section 4.3 (reasonable doubt), that a fair separation rating recommendation for the MDD/anxiety disorder was 50 percent in this case.

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

BOARD VOTE:

____X____  ____X____  ____X____  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The Board determined that the evidence presented was sufficient to warrant a recommendation for relief.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by modifying her prior determination to reflect that the MDD with comorbid 

generalized anxiety disorder condition was rated at 50 percent rather than 30 percent, effective as of the date of her prior medical separation. 



      ___________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)                                  AR20140006934



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