IN THE CASE OF:	

		BOARD DATE:	  6 August 2014

		DOCKET NUMBER:  AR20140011591 


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 medical 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 reviewed the records for evidence of inappropriate changes in diagnosis of the MH condition during processing through the military Disability Evaluation System (DES).  Because the applicant was referred into the DES process with a diagnosis of Post-Traumatic Stress Disorder (PTSD), but 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 met the inclusion criteria in the Terms of Reference of the MH Review Project. 

4.  The SRP agreed that the 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 depressive disorder (MDD) at the time of separation.  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 (placement 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).  However, since the PEB adopted the VA’s recommended 70 percent rating, the SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 70 percent at time of placement on the TDRL.

5.  The SRP noted that the disability associated with all psychiatric conditions, regardless of the diagnosis, was subsumed under a single rating using the same criteria in accordance with (IAW) VASRD Section 4.130.  The next higher 

100 percent rating was described by “total occupational and social impairment.” The absence of threshold symptoms of the next higher 100 percent rating, for example, persistent delusions or hallucinations, disorientation to time or place,
grossly inappropriate behavior, or memory loss for names of close relatives, own occupation, or own name was considered.  The commander’s statement indicating no performance issue was also noted. 

6.  The SRP agreed that “total occupational and social impairment” was not
described by the evidence, and therefore concluded that a rating higher than 70 percent at the time of placement on the TDRL was not supported.  Next, the SRP turned its attention to a rating recommendation at the time of removal from the TDRL.  The PEB quoted the VASRD Section 4.130 criteria (“occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks”) in assignment of a 30 percent rating, and also changed the diagnosis to dysthymic disorder, coded 9433. 

7.  The SRP emphasized that the change in diagnosis was irrelevant to the rating, and the SRP considered if a rating higher than 30 percent was justified.  The next higher 50 percent rating required “occupational and social impairment with reduced reliability and productivity.”  While there were one or possibly two 50-percent threshold symptoms, the SRP noted that there was no missed work,
and work relationships were good.  Social impairment was evident in his reported isolation, yet his family relationships were intact. 

8.  The SRP also noted that during the TDRL interval there were no reported visits to the emergency room for MH treatment, no psychiatric hospitalization,
and no legal issues.  The TDRL MH re-evaluation examiner used 30-percent rating language in describing the condition’s impairment.  The SRP concluded that the evidence just described was not consistent with the “reduced reliability and productivity” stipulation of the 50 percent rating.  Therefore, a 50 percent rating at the time of removal from TDRL was not supported and the condition
was most accurately described by the 30 percent rating.

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 insufficient cause to recommend a change in the PEB adjudication for the MH 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)                                  AR20140011591



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