IN THE CASE OF:	  

		BOARD DATE:	    10 September 2014

		DOCKET NUMBER:  AR20140013446 


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 determinations. 

2.  The SRP noted that following the applicant’s return from Iraq and her subsequent hospitalization, she was diagnosed with a major depressive disorder (MDD) by her Department of Veterans Affairs (VA) providers and the psychiatrist who wrote the narrative summary (NARSUM) listed MDD on the DA Form 3349 in September 2005.  The medical evaluation board (MEB) medical examination (DD Form 2808), however, listed Post-Traumatic Stress Disorder (PTSD) as a diagnosis while MDD was crossed out.  The NARSUM dated December 2005 documented PTSD and that was the condition listed on the permanent profile issued in February 2006 and forwarded by the MEB in May 2006.  The physical evaluation board (PEB), however, adjudicated MDD.  The SRP concluded the applicant’s case appeared to meet the inclusion criteria for the Terms of Reference of the MH Review Project.

3. The SRP next turned to a discussion of the appropriateness of the diagnosis.  The SRP noted, as had the PEB, that the applicant was diagnosed with MDD following her return from Iraq and her subsequent hospitalization.  She had continuously displayed depressive symptomatology from that time until the PEB (as well as thereafter).  The NARSUM author stated all of the criteria for PTSD was met including criteria A1 and A2 (stressor threat and response) during deployment.  However, it appeared the PEB had data indicating the applicant's experiences of trauma during the deployment were at variance with actual events.  This data was not available for review as it involved telephonic discussion with the PEB directly.  

4.  The SRP determined the fact that the applicant's description of trauma and the reexperiencing of it were vague and the distress she experienced such as guilt, isolation, and anxiety was seen as relating to the MDD diagnosis (for which all criteria appeared to have been met) rather than PTSD.  The SRP noted her VA providers had consistently documented MDD and that this was the diagnosis made on the Compensation and Pension (C&P) exams as well.  Finally, it appeared the author of the NARSUM eventually concurred with a diagnosis of MDD, documenting it in his Temporary Disability Retirement List (TDRL) examinations.  The SRP unanimously concluded the preponderance of evidence was insufficient to support a change in the MDD diagnosis adjudicated by the PEB.

5.  The SRP noted the final PEB diagnosis, the VA Schedule for Rating Disabilities (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.  The SRP also noted that while the NARSUM examiner had felt criteria A1 and A2 (stressor threat and response) for PTSD was met, the evidence for a combat stressor appeared unsubstantiated and was apparently contradicted by other testimony to the PEB.  The SRP concluded there was insufficient evidence to support the conclusion that a highly-stressful event severe enough to bring about the veteran's release from active military service occurred, so the application of VASRD Section 4.129 was not appropriate in this case. 

6.  The SRP noted the psychiatrist, in his response to the PEB 9 months prior to the applicant's placement on the TDRL, stated he considered her “social/ industrial impairment was considerable (i.e., at 50 percent)."  She was described as having one panic attack (not objectively evidenced) per week and tended to seclude herself.  She was not able to take care of her daughter, causing her husband to be the primary caregiver.  She was irritable, hyper-vigilant, and her mood was depressed.  The C&P exam in October 2007 (11 months after placement on the TDRL) stated that there were "signs and symptoms resulting in deficiencies in family relationships, work, mood and school," which resulted in a rating by the VA of 30 percent.   

7.  The SRP discussed whether the level of disability at the time of entrance onto the TDRL was best described by the PEB's adjudication of 30 percent or a higher level of disability.  The SRP majority concluded that at the time of entrance onto the TDRL the applicant's level of functioning was best characterized as meeting the 30 percent rating level.  The single voter for dissent submitted the attached minority opinion.  At removal from the TDRL, the psychiatric evaluator, while documenting a diagnosis of MDD, stated "there was reduced reliability and productivity due to PTSD signs and symptoms."  The most proximate VA C&P exam from May 2010 (almost 18 months prior to the applicant's removal from the TDRL) mentioned the history of two suicide attempts and a previous psychiatric admission in January 2009.  It mentioned difficulty in maintaining appropriate interpersonal relationships with neighbors, friends and families, and stated that impairment of social/industrial functioning was "severe."  The SRP concluded the applicant's level of disability at the time of removal from the TDRL was not higher than the 50 percent rating level awarded by the PEB.
8.  The appended minority opinion, prepared by the single dissenter, recommended no change in the applicant’s unfitting diagnosis, and that her prior separation be modified to reflect she was placed on the TDRL at 50 percent and then permanently retired with an unchanged final 50 percent rating. 

9.  After due deliberation in consideration of the preponderance of the evidence, the SRP majority recommended no change to the applicant’s disability and retirement determination.

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)                                  AR20140013446



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