IN THE CASE OF:  	  

		BOARD DATE:  17 September 2014  	  

		DOCKET NUMBER:  AR20140014465 


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 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 MH 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 to the applicant’s disability and separation determinations. 

2.  The SRP considered the appropriateness of changes in the MH diagnoses, the physical evaluation board (PEB) fitness determination; and a disability rating recommendation in accordance with the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.130.  The applicant was diagnosed with Post-Traumatic Stress Disorder (PTSD) by the PEB and placed on Temporary Disability Retired List (TDRL), April 2009, with an entry rating of 50 percent based on medical evaluation board (MEB)/narrative summary (NARSUM) evaluation of February 2009.  He was removed from the TDRL in March 2013 and given a permanent rating of 50 percent based on a NARSUM evaluation on 27 February 2013.  The SRP determined that no MH diagnoses were changed to the applicant’s possible disadvantage in the Disability Evaluation System and that Section 4.129 was appropriately applied.  Therefore, the applicant did not appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project.

3.  The SRP undertook to determine if the evidence in record supported a rating higher than 50 percent in accordance with (IAW) VASRD Section 4.130 at the time of placement on the constructive TDRL.  The next higher rating, 70 percent, required occupational and social impairment, with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and an inability to establish and maintain effective relationships.

4.  The SRP noted the applicant’s MEB/NARSUM exam, prepared 2 months prior to TDRL placement, reported intrusive images of dead bodies.  He reported loss of interest, avoidance, exaggerated startle response and hyper-vigilance, but noted that these were improved on medication.  The applicant’s mental status exam (MSE) indicated he was irritable and mildly depressed.  Suicidal (SI) and homicidal (HI) ideations and hallucinations (H) and delusions (D) were absent.  Mood, affect, judgment, insight and intellectual function were normal.  At a psychiatric clinic evaluation, the month of TDRL placement, the examiner noted that the applicant was “employed” and “motivated for treatment.”  The applicant was described as “relaxed, pleasant and logical.”  MSE was normal without SI, HI, H, or D.  On assiduous review, the SRP unanimously agreed that the preponderance of evidence in the record did not support a higher rating than 50 percent at TDRL entry.  The SRP next undertook to determine if the evidence in record supported a rating higher than 50 percent IAW VASRD Section 4.30 at time of removal from TDRL. 

5.  The SRP noted that on the TDRL-Exit NARSUM, performed 4 years after TDRL placement, the applicant reported one episode of hospitalization 3 years prior for the MH condition but noted an overall “slight improvement” in his MH condition since TDRL placement.  He noted continued fear of crowds and “scanned everyone” when he went to church and nightmares two to three times a week.  He was living with a girlfriend and had good relations with his daughter and mother and was forming friendships with church members.  The applicant was working part-time in one job but was unable to hold down another full time job because the work was “loud and falling work materials reminded him of explosions.”  The applicant’s MSE indicated he was casually dressed, oriented, professional, and polite.  No SI, HI, H, D, panic attacks or obsessive/compulsive behavior were noted.  Global Assessment of Functioning (GAF) was 65 (70-61... some mild symptoms or some difficulty in occupational functioning, but, generally doing pretty well; has some meaningful interpersonal relationships).  On review, the SRP unanimously agreed that the preponderance of evidence in the record did not support the criteria for a permanent rating higher than 50 percent at TDRL exit. 

6.  After due deliberation  in consideration of preponderance of the evidence, the SRP concluded that there was insufficient cause to recommend a change in the PEB adjudication of the applicant’s MH condition at the time of TDRL entry and permanent separation.

7.  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)                                  AR20140014465



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