IN THE CASE OF:	  

		BOARD DATE:	  11 June 2014

		DOCKET NUMBER:  AR20140007638 


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 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 in the applicant's unfitting condition diagnosis or Temporary Disability Retired List (TDRL) rating and that his prior permanent separation rating should be modified to 10 percent.

2.  The SRP considered the appropriateness of changes in the MH diagnoses; the physical evaluation board (PEB) fitness determination; if unfitting, whether the provisions of the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (VASRD), section 4.129, were applicable; and a disability rating recommendation in accordance with VASRD, section 4.130.  Since the Service acknowledged and rated the post-traumatic stress disorder (PTSD) condition, there was no question regarding an unfavorable elimination or downgrading of the MH diagnosis.  The SRP agreed this case did not meet the inclusion criteria of the MH review project terms of reference.

3.  The SRP later turned to a discussion of the appropriateness of the diagnosis. While there was no examination in the available evidence which elaborated in detail how each criteria for the diagnosis of PTSD had been fulfilled, it appeared that the diagnostic summary in the August 2008 examination narrative summary described a symptom complex consistent with that diagnosis, including a greater than 6-month history of distressing recollections of combat experiences, insomnia, nightmares, irritability, anxiety, guilt, hypervigilance, and impairment of relationships.  The SRP agreed there did not appear to be a preponderance of evidence to support a change in the unfitting diagnosis.

4.  The SRP determined that VASRD, section 4.129, had been appropriately applied in this case and that there was no data to support a rating higher than the required 50 percent at the applicant's time of entry on the TDRL.   Discussion then focused on the issue of the disability rating at the time of removal from the TDRL.  The SRP agreed there was insufficient evidence to support a 30-percent or higher rating at permanent separation and focused detailed deliberations on a 0-percent or 10-percent permanent rating.

5.  The SRP considered that the Service TDRL examination in March 2010 had described the applicant as manifesting clinically mild symptoms "with some occasional issues with staying asleep, nightmares of combat, and irritable mood" and "moderate symptoms, moderate impairment of social and occupational functioning."  Neurocognitive testing performed 2 days previously had documented "PTSD, Per History" and had assigned a Global Assessment of Functioning (GAF) score of 85 signifying "absent or minimal symptoms." Similarly, the VA Compensation and Pension (C&P) PTSD examination performed in January 2010, while documenting depression (not otherwise specified (NOS)) and anxiety disorder (NOS), stated the applicant was not suffering from PTSD and did not meet the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria for that diagnosis.

6.  The SRP noted the applicant referred himself to the VA within a week of his removal from the TDRL because of problems with sleep and irritability.  According to a subsequent note, he tolerated medication and seemed to be responding to it.  At that time, he was working full time and was living at home with his wife and children.  A biopsychosocial assessment in August 2010 stated he enjoyed hunting and fishing.  He felt he could find time and did enjoy these activities.  He was also reported to have a good support system with his family and friends.  The VA records later indicated continued MH treatment and medications with a lower assessment of functioning and the VA reinstated the applicant's 50-percent MH rating effective 1 September 2010, which was the date of the prior reduction.

7.  The SRP noted that while the Service TDRL examiner stated with regard to the applicant's current level of functioning that "he currently experienced no significant limitations in any sphere life and that despite his clinical improvement, it was unlikely that he would ever improve to the point that he could remain in remission in active military environment."  Additionally, when removing him from the TDRL, the PEB noted the psychiatrist doubted he would improve to the point that he could remain in remission in an active duty environment.

8.  The SRP considered whether the fragility of the MH condition reflected in these statements implied impairment solely for military functioning or whether civilian occupational functioning would also be affected by the MH condition.  The VA evidence clearly supported increased symptoms which could be attributed to a stressful period immediately after TDRL exit.  Given the mild symptoms noted in the Service evaluation, the examiner's characterization of the Axis V general functioning as moderate symptoms, moderate impairment of social and occupational functioning, the majority of the SRP determined that in accordance with VASRD, section 4.3 (reasonable doubt), the applicant's rating level was best described by the 10-percent criteria of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.

9.  After due deliberations in consideration of the preponderance of the evidence, the SRP concluded that there was insufficient evidence to support a permanent rating greater than 10 percent.

10.  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 the evidence presented is 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 the applicant's prior permanent separation rating to 10 percent.



      _______ _   _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)                                  AR20140007638



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