IN THE CASE OF: 

		BOARD DATE:	  14 August 2014

		DOCKET NUMBER:  AR20140010890 


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 recommends by unanimous vote, that the disability rating should be modified.

2.  The SRP considered the appropriateness of changes in the MH diagnoses, Physical Evaluation Board (PEB) fitness determination, whether the provisions of 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 first considered the appropriateness of any changes in the MH diagnoses.  The examiner who accomplished the Medical Evaluation Board (MEB) physical on 8 November 2006 listed Post-Traumatic Stress Disorder (PTSD) as a diagnosis.  The applicant had been given the diagnosis of PTSD by clinicians in the VA medical system, but the psychiatrist who examined the applicant for the Medical Evaluation Board (MEB) diagnosed anxiety disorder, not otherwise specified (NOS), because specific trauma exposure could not be verified.  The narrative summary (NARSUM) dated the following day, though, listed PTSD as the MH condition. 

4.  The SRP noted that this was changed after receipt of the MEB psychiatric evaluation.  The MEB forwarded the MH diagnosis of anxiety disorder to the PEB for adjudication.  The PEB adjudicated the applicant for anxiety disorder, NOS, at Temporary Disability Retired List (TDRL) entry and PTSD at TDRL removal.  The SRP determined that while the MH diagnosis was changed in the disability evaluation process, the diagnosis was changed back to PTSD prior to final disposition.  Therefore, the applicant did not meet the inclusion criteria in the Terms of Reference of the MH Review Project.

5.  The SRP considered the MH diagnosis and determined that the preponderance of evidence supported a diagnosis of PTSD at both TDRL entry and exit and that the code for PTSD, VASRD 9411, should be utilized for both TDRL entry and exit. 

6.  The SRP then considered whether the provisions of VASRD section 4.129 were applicable.  Regardless of the diagnosis at TDRL entry, the applicant clearly linked his symptoms to the trauma experienced while deployed.  The SRP concluded that sufficient evidence supports that a highly-stressful event severe enough to bring about the Veteran’s release from active military service did occur, so the application of §4.129 is appropriate in this case.  VASRD §4.129 does not specify a diagnosis of PTSD, rather it states “mental disorder due to a highly stressful event,” and its application is not restricted to PTSD; therefore, it is  applicable in this case.

7.  The SRP noted that the PEB did not apply VASRD §4.129, and the applicant was on TDRL for more than the minimum 6 months directed by DoD policy and DoD Instructions 1332.38.  The SRP next considered the appropriate rating in accordance with (IAW) VASRD section 4.130 for TDRL entry and exit. 

8.  After careful consideration of the evidence, the SRP concluded the level of disability at TDRL entry was not higher than the minimum 50 percent rating, occupational and social impairment with reduced reliability and productivity, IAW VASRD section 4.129.  The PEB adjudicated a 50% rating at TDRL removal for PTSD.  The applicant’s prognosis was considered poor due to treatment noncompliance and substance dependence.  The SRP considered the description for a 70 percent rating “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.”  The SRP determined that the impairment from the MH condition did not meet the criteria for this level of disability.  Accordingly, no change in the PEB adjudication at TDRL removal is recommended.

9.  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 determinations as indicated below:


UNFITTING CONDITION		
VASRD CODE
 
TDRL       RATING             
PERMANENT
RATING
Post-Traumatic Stress Disorder
9411
50%
50%
Stress Urinary Incontinence
7527
40%
40%
Status Post Posterior Laminectomy and Interbody Fusion
5241
20%
20%

COMBINED
80%
80%


      __________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)                                  AR20140010890



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