IN THE CASE OF:	  

		BOARD DATE:	  6 August 2014

		DOCKET NUMBER:  AR20140008292 


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 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.  A response was received from an Advocate on behalf of the applicant that states in effect:

	a.  The applicant made homicidal and suicidal threats under the supervision of his noncommissioned officer (NCO), Staff Sergeant (SSG) T, while performing duties in the field at Fort Irwin and in the Dining Facility.  This was verbally confirmed in person with his NCO when SSG T was challenged with not forwarding the details to the chain of command or submitting a Warrior Transition Unit (WTU) packet on his behalf.  The compounding issues surrounding PTSD, panic disorder, sleep apnea, alcohol dependence came full circle when he threatened suicide if Mrs. C preceded his departure and returned home before his medical board and separation orders were finalized. 

	b.  After attempting to secure assistance from the behavioral health department at Fort Irwin, Mrs. C sought help to secure a compassionate reassignment, transfer into a WTU or an expedition of the medical evaluation board (MEB) decision and contacted the commander at Weed Army Hospital, Director of Clinical Services, Patient Advocate Representatives, WTU leaders, Inspector General, Ombudsman and was finally advised to contact specific officers in his chain of command.  During a subsequent meeting with his commanding officers and chaplain, it was dictated the team would do whatever possible to expedite the medical board review or other avenues to relieve him from his duty responsibilities and attend to his failing mental health.  Changes were made to his schedule and field duties, and placement at the Aurora Psychiatric Treatment Center was being arranged should his condition worsen or Mrs. C depart Fort Irwin before termination orders were processed.

	c.  Contrary to a report of no emergency room visits in the decision letter, he was transported to the hospital by his assigned NCO and assessed in the emergency room at the Fort Irwin Weed Army Hospital a number of times for anxiety/panic prior to MEB review.  One could ascertain the only reason he did not initially miss time from work is because the negligence of his NCO was not revealed.  He was obviously an asset that no one wanted to lose in the field environment.  There were a number of Mental Status Reports conducted prior to departing Fort Irwin via Desert Behavioral Health in Apple Valley as well as through Behavioral Health at the Mary Walker Clinic and many individual and shared counseling sessions where Mrs. C accompanied him. 

	d.  Although he is attending college, he is not performing well, even with accommodations in place for his disabilities.  Contrary to previous reports, his speech, abstract thinking, judgment, impulse control and orientation are all poor. Additional medication has been added to his list of psychotropic medicines with hopes to improve judgment, impulse control, attention, etc. with little improvement.  The examiner who conducted his BH examination would have needed to note behaviors presenting on a consistent basis to include aggressive outbursts, depression, recurrent panic episodes, and homicidal ideation.  There is a constant concern for his health and his challenges have fatigued the family, especially his wife. 

	e.  There were difficulties surrounding his brief stay at and departure from Poplar Springs Psychiatric Hospital in March 2013 that included daily co-pay the family could not afford as well as the inclusion of a civilian population that was anti-military.  These challenges did not present a conducive environment or situation for effective treatment or therapy. Because his condition has worsened with insufficient evidence to support a claim for an increased rating to 70% documenting occupational and social impairment with deficiencies in most areas to include school, work, family relations, judgment, thinking, and mood, other measures are being procured on his behalf.  He refused medical treatment when emergency services were called to his home after severe panic attacks in December 2013 and after a home visit by a home health nurse in May 2014.  All solicitations through the McGuire Department of Veterans Affairs (VA) Hospital, caregiver support, couples therapy, outpatient therapy, and VA medication management, have not been effective in reducing his symptoms and/or his negative and compulsive behavior. He will be entering a residential post-traumatic stress disorder (PTSD) program at the Hampton VA Hospital for treatment and hopeful recovery.

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 applicant's disability and retirement determination.

2.  The SRP considered the appropriateness of changes in the applicant's MH diagnoses, Physical Evaluation Board (PEB) fitness determination, whether the provisions of VA Schedule for Rating Disabilities (VASRD) section 4.129 were applicable, and whether a disability rating recommendation in accordance with VASRD section 4.130 was made. 

3.  The SRP reviewed the records for evidence of inappropriate changes in diagnosis of the MH condition during processing through the military Disability Evaluation System.  The SRP determined that the MH diagnosis was not changed to the applicant's possible disadvantage in the disability evaluation.  Therefore, the applicant did not meet the inclusion criteria in the Terms of Reference of the MH Review Project. 

4.  The advocate’s response is not supported by the record.  The available record indicates that the examiner who conducted the applicant’s MH exam did not note the behaviors described included outbursts, depression, recurrent panic episodes and homicidal ideation on a consistent basis.

5.  Additionally, the advocate states that the applicant’s condition has worsened.  The evidence in record is without sufficient evidence to support claim for an increased rating.  The advocate notes that the applicant refused medical treatment in May 2014 and, in effect, the various treatments for the applicant have not been effective.

6.  The SRP considered if there was evidence for a VASRD section 4.130 rating higher than 50 percent at time of placement on the Temporary Disability Retired List (TDRL).  The SRP noted that although there were one or two threshold symptoms that could possibly support a higher rating, it was noted that there were no visits to the emergency room for MH treatment and no legal issues.  Although a hospitalization 6 months after TDRL entry could signify a worsened severity possibly justifying a higher rating, specific rating parameters were not in evidence.  Therefore, a higher rating at the time of entry on the TDRL was not supported. 

7.  After due deliberation, considering all of the evidence the SRP concluded that there was insufficient cause to recommend a change in the PEB adjudication for the PTSD condition.

8.  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 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)                                  AR20140008292



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