IN THE CASE OF:	 

		BOARD DATE:	    9 July 2014

		DOCKET NUMBER:  AR20140009057 


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 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 recommended by unanimous vote that there be no change to the applicant’s Temporary Disability Retired List (TDRL) entry rating and modification of the prior permanent retirement to reflect a final 70 percent rating.

2.  The SRP reviewed the records for evidence of inappropriate changes in
diagnosis of the mental health condition during processing through the Disability Evaluation System (DES).  The evidence of the available records shows the diagnoses of Post-Traumatic Stress Disorder (PTSD) and depression were rendered during processing through the DES.  The SRP agreed that the diagnosis of depression was eliminated during the DES process; however, the SRP determined that the MH diagnoses were 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.

3.  The SRP further agreed that physical evaluation board (PEB) adjudication of unfitting PTSD was supported by the evidence; therefore, the diagnosis of PTSD was the appropriate diagnosis and application of the provisions of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 was correct (Mental disorders due to traumatic stress) for application at TDRL entry. 

4.  The SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at time of placement on the TDRL.  The higher 70 percent rating was for “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.” Treatment records at the time leading up to TDRL entry recorded no history of suicidal ideation, no visits to the emergency room for panic attacks or other psychiatric symptoms, and no MH hospitalization.  There was no evidence of impairment in judgment or thinking and no abnormality recorded in the narrative summary (NARSUM) mental status examination (MSE).  There was evidence of impairment in his marital relationship. 



5.  The SRP determined that there was insufficient reasonable doubt (in accordance with (IAW) VASRD Section 4.3) for recommending a 70 percent TDRL entry rating and that the record in evidence best supported the 50 percent rating for TDRL entry.  The SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at time of medical retirement.  The applicant was never hospitalized psychiatrically or treated in the emergency room for psychiatric symptoms and had no legal issues since TDRL entry. 

6.  The SRP noted the TDRL exit examination on 14 January 2010, approximately 15 months into the TDRL, indicated the applicant was awaiting individual therapy with the VA and continued with medication management.  The applicant continued to report PTSD symptoms as adversely impacting his ability to interact with others occupationally (he was released from the Federal Emergency Management Agency due to irritability and anger outbursts) and socially. 

7.  The SRP also noted the applicant abused alcohol “to escape” and missed work as a result of his bad hangovers; he did not state the number of days missed nor his place of employment.  His MSE was normal except for an irritable and anxious mood.  The examiner noted that the applicant had minimal social contact and did not participate in social events.  The examiner recommended continued follow-up with the VA and participation in a substance abuse treatment.  The SRP agreed that the applicant’s PTSD condition was stable, but had worsened at the time of medical retirement. 

9.  After due deliberation in consideration of the preponderance of the evidence, and mindful of VASRD Section 4.3 (reasonable doubt), the SRP concluded that there was sufficient cause to recommend a change in the PEB adjudication to a 70 percent disability rating for the applicant’s mental health condition at medical retirement.

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 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 the applicant’s prior temporary and permanent determinations as indicated below:

UNFITTING CONDITION		
VASRD CODE

TDRL       RATING             
PERMANENT
RATING
Post-Traumatic Stress Disorder 
9411
50%
70%


      _______ _   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)                                  AR20140009057



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