IN THE CASE OF:	  

		BOARD DATE:	  6 August 2014

		DOCKET NUMBER:  AR20140011590 


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 determined by unanimous vote that there should be no change of the applicant’s disability and retirement determination.

2.  The SRP reviewed the records for evidence of inappropriate changes in
diagnosis of the MH condition during processing through the Integrated Disability Evaluation System (IDES).  The evidence of the available records recorded no inappropriate changes in diagnoses to the applicant’s possible disadvantage during the Disability Evaluation Process (DES) process.  Therefore, the applicant did not appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project.

3.  The SRP agreed that physical evaluation board (PEB) adjudication of the unfitting major depressive disorder (MDD) was supported by the evidence and application of the provisions of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 were appropriately applied at Temporary Disability Retired List (TDRL) entry; however, the SRP noted its application was being used for re-evaluation purposes.  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.”  Available treatment records at the time leading up to TDRL entry recorded no history of suicidal ideation.  There were no psychiatric hospitalizations, no aggressive behaviors, no visits to the emergency room for MH issues, and no evidence of impairment in judgment or thinking.

4.  The SRP noted the available treatment records documented good response to medication.  Available records demonstrated occasional visits to MH with all mental status examinations being essentially normal up to the time of his last MH visit in March 2010.  There was no indication from the record that the MH condition was ever profiled and no MH condition was implicated in the commander’s statement.  The SRP concluded there was insufficient reasonable 

doubt (in accordance with (IAW) VASRD Section 4.3 or Section 4.7) for
recommending a 70 percent TDRL entry rating.

5.  The SRP next considered the rating for TDRL removal.  At the TDRL removal examination on 5 March 2012, approximately a year after TDRL placement, the applicant reported a depressed mood secondary to his decreased ability to participate in activities related to his left leg amputation.  He slept 3-4 hours per night on most nights.  He maintained an interest in cooking, fishing, listening to music, watching football and boxing, and enjoyed hanging out with friends at
cookouts.  He denied having decreased energy and said he did not feel tired even after getting 4-5 hours of sleep.  He reported his concentration was better at times than others, but did not think he had a problem with ability to focus and concentrate.  His appetite was good, he denied angry outbursts but did endorse feeling upset easily when dealing with normal stressors.  The applicant reported pain associated with the amputation.  He noted he was not working and had
not worked or returned to school since his departure from the military.  He reported a great relationship with his wife and children.  His typical day included getting up around 6 am to help his wife with his child’s school preparations, and running errands for his wife and other extended family members.  He tended to socially isolate but enjoyed engaging in social activities outside of the home.  He acknowledged a pattern of social use of alcohol.  He denied thoughts of self-harm.  His mental status examination (MSE) was completely normal.  The psychiatrist noted, “He did not endorse symptoms severe enough to meet criteria for major depressive disorder” and opined his depressed mood “was likely related to an adjustment disorder; he had not sought behavioral health treatment.”  The examiner wrote “he did not have major depression, that disorder has fully remitted and the current diagnosis was adjustment disorder with depressed mood, chronic.”  A Global Assessment of Functioning (GAF) of 65-70 was assigned.  As stated, the PEB disagreed with the examiner and continued the diagnosis of MDD with a permanent disability rating of 50 percent.

6.  The SRP considered the descriptions for the higher rating of 70 percent, “Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood,” and all members agreed the evidence of record did not support the 70 percent rating.  Specifically, there was no evidence of social impairment, and as noted by the PEB no available evidence of occupational impairment since the applicant had not worked.  Although he had not worked or returned to school, by the applicant’s report he had no difficulty with focus, concentration, or mobility.  He was able to run errands and enjoy multiple social activities.  There was no evidence of 

impaired judgment or thinking.  The applicant reported a great relationship with his wife; however, his wife wrote a letter to the PEB after the initial retirement decision of a 0 percent rating. 

7.  In the letter she stated “his behavior was not better, he needed depression pills; he felt sad, and cannot enjoy football or basketball because he can’t do the things he used to do so he isolates himself.”  The applicant also wrote a letter stating he was seeing a doctor and taking depression medication.  Medication profile post-TDRL placement noted that from 17 April 2011-12 June 2012 psychotropic medications had either expired or were discontinued.  On 8 June 2012, prescriptions for Zoloft and Ambien were recorded.  The VA chemical dependency clinic wrote on 16 May 2012 that the applicant had marital issues complicated by his use of alcohol.  It was noted in a previous social work note that the applicant was verbally abusive towards his wife who had put him out of the home and had placed a restraining order placed on him.  The applicant agreed to enroll in the alcohol abuse program.  A prior social work note on         14 May 2012 recorded the applicant was off his psychotropic medications.  The SRP determined that the evidence did not support a rating higher than the 50 percent rating. 

8.  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 insufficient cause to recommend a change in the PEB adjudication for the MH condition at either TDRL entry or removal.

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)                                  AR20140011590



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