IN THE CASE OF:	  

		BOARD DATE:	  30 July 2014

		DOCKET NUMBER:  AR20140010917 


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 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 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 the MH diagnoses and a disability rating recommendation in accordance with the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.130. 

3.  The SRP noted that the applicant was referred into the Disability Evaluation System (DES) process with a diagnosis of Post-Traumatic Stress Disorder (PTSD).  The VA examination (which was considered part of the DES process), narrative summary (NARSUM), medical evaluation board (MEB), and physical evaluation board (PEB) listed a diagnosis of major depression.  The SRP concluded the MH diagnosis was changed in the disability evaluation process and therefore the applicant met the inclusion criteria in the Terms of Reference of the MH Review Project.  

4.  The SRP agreed that the detailed evaluation by the VA Compensation and Pension (C&P) examiner specified the absence of the required PTSD diagnostic criteria and provided a preponderance of evidence favoring the diagnosis of major depression at the time of separation.  

5.  The SRP noted that the  provisions of VASRD Section 4.129 (mental disorders due to traumatic stress) were applied by the PEB as directed by Department of Defense (DoD) policy in the placement of the applicant on the Temporary Disability Retired List (TDRL) with a minimum rating of 50 percent for a period of 6 months before reevaluation and re-adjudication).  The SRP also considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at time of placement on the TDRL. 

6.  The SRP noted the disability associated with all psychiatric conditions regardless of the diagnosis was subsumed under a single rating using the same criteria in accordance with VASRD Section 4.130.  The next higher 70 percent rating required “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.”  It was noted that there were no visits to the emergency room for MH treatment and no psychiatric hospitalization.  The absence of any threshold symptoms of the next higher 70 percent rating, for example, impaired impulse control, spatial disorientation, obsessional rituals, and neglect of personal appearance and hygiene was also considered.  The SRP concluded that the 70 percent criteria was not reflected in the evidence and therefore agreed that a rating higher than 50 percent was not supported at the time of the applicant's entry on TDRL.

7.  The SRP later turned its attention to a rating recommendation at the time of the applicant's removal from the TDRL.  The PEB quoted the VASRD Section 4.130 criteria (“occupational and social impairment with reduced reliability and productivity”) in assignment of a 50 percent rating.  The SRP considered if a rating higher than 50 percent was justified.  The TDRL re-evaluation examiner cited the 30 percent rating language in describing the condition's impairment, but this appeared somewhat inconsistent with a Global Assessment of Functioning (GAF) score suggesting more serious impairment.  The SRP debated the significance of anger management issues and unemployment, but also noted plans to attend school, family relationships that were “good,” and the possible presence of only one 70 percent threshold symptom.  

8.  The SRP also noted that there were no reported visits to the emergency room or hospitalization for MH treatment.  Ultimately, it was concluded that the evidence just described was most consistent with the “reduced reliability and productivity” stipulation of the 50 percent rating.  Therefore, the evidence at the time of removal from TDRL was most accurately depicted by the 50 percent rating.

9.  After due deliberation, considering all of the evidence and mindful of VASRD Section 4.3 (reasonable doubt), the SRP concluded that there was insufficient cause to recommend a change in the PEB adjudication for the major depression condition.

10.  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)                                  AR20140010917



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