BOARD DATE:	  23 July 2014

		DOCKET NUMBER:  AR20140010688 


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 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 Department of Defense 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 of the applicant’s disability and retirement determination. 

2.  The SRP considered the appropriateness of changes in MH diagnoses; the physical evaluation board (PEB) fitness determination; and if unfitting, whether the provisions of the Department of Veterans Affairs 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 noted the diagnosis of Post-Traumatic Stress Disorder (PTSD) was mentioned in the applicant's service record.  PTSD was listed in the medical evaluation board (MEB) DD Form 2808 (Report of Medical Examination) dated 20 July 2009 under the summary of defects and diagnoses (block 77), and on the DA Form 3349 (Physical Profile) dated May 2009.  The commander’s statement dated 8 July 2009 appeared to indicate that the Disability Evaluation System (DES) had begun at that time.

4.  The SRP noted that the narrative summary (NARSUM) (October 2009) had discussed the issue of PTSD and determined that the required criteria for the PTSD diagnosis was not met.  Since PTSD did not appear on the final PEB, the SRP concluded that the applicant did meet the inclusion criteria of the Terms of Reference of the MH Review Project. 

5.  The SRP later turned to a discussion of the appropriateness of the diagnosis. A review of the available data indicated that the applicant had demonstrated a number of symptoms consistent with PTSD following his return from deployment.  However, thorough discussion of the PTSD screen in the NARSUM, in addition to the concurring diagnoses in the three Compensation and Pension (C&P) exams, led the SRP to conclude that the preponderance of the evidence did not support any change in the anxiety disorder, not otherwise specified (NOS) diagnosis adjudicated by the PEB.  Regardless of final PEB diagnosis, VASRD Section 4.129 did not specify a diagnosis of PTSD, rather it stated “mental disorder due to a highly stressful event” and its application was not restricted to PTSD.

6.  The SRP considered that the nature and timing of the applicant's symptoms strongly implied a relationship between a stressful event during deployment and
the development of a condition that had become unfitting for further military service.  The SRP concluded that the PEB had appropriately applied VASRD 4.129 in this case.  Regarding the rating at the beginning of the Temporary Disability Retired List (TDRL) period, the SRP considered that the NARSUM exam was most proximate to the date of placement on TDRL.  That exam had assigned a Global Assessment of Functioning (GAF) score of 65 (mild range) and assessed the applicant’s overall level of functioning at 4/10.  The examiner described “decreased efficiency in the occupational realm and mild relational conflict with his wife” which seemed to align with a VASRD Section 4.130 rating of 30 percent.  The examiner also specified that while “his prognosis for further military service was poor to fair…his prognosis for the civilian sector was good due to the decreased level of stress of the civilian environment.”  Based on the NARSUM, the PEB stated that an actual 30 percent level of disability would be appropriate although it assigned the 50 percent rating required by application of VASRD Section 4.129.

7.  The SRP concluded that, based on the data available at the time of the applicant placement on the TDRL, there was not sufficient evidence to support a rating higher than 50 percent for the MH condition as awarded by the PEB.  Regarding the rating at the end of the TDRL, the C&P exam performed 6 months prior to the final PEB specified that there had been little if any improvement, that the applicant remained unemployed, was about to be divorced and continued to exhibit symptoms of mental illness.  Disability was described as “deficiencies in most areas such as work, school, family relations, judgment thinking and mood” suggestive of a VASRD Section 4.130 rating of 70 percent.

8.  After due deliberation in consideration of the preponderance of the evidence, the SRP agreed that the level of disability described in that evaluation was consistent with a 70 percent rating for the MH conditions and there was insufficient evidence to recommend any higher rating at the time of the applicant removal from the TDRL.

9.  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 that 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)                                  AR20140010688



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