IN THE CASE OF:	  

		BOARD DATE:	  23 September 2014

		DOCKET NUMBER:  AR20140014546 


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 to the applicant’s disability and separation determination.

2.  The SRP reviewed the records for evidence of inappropriate changes in a
diagnosis of the MH condition during processing through the military Disability Evaluation System (DES).  The evidence of the available records showed diagnoses of anxiety disorder not otherwise specified (NOS) and Post-Traumatic Stress Disorder (PTSD) were rendered during processing through the DES.  PTSD was listed on the medical evaluation board (MEB) physical examination, with no recorded clinical justification for the diagnosis.  The MEB narrative summary (NARSUM) contained an unclear MH diagnosis entry of anxiety (PTSD) NOS, and noted the applicant was in treatment with the psychologist for that diagnosis.  

3.  The SRP undertook a careful review of the clinical records and found no PTSD diagnosis rendered by an MH professional.  The psychologist referenced in the NARSUM recorded the diagnosis as anxiety disorder NOS, and although the applicant reported involvement in an improvised explosive device (IED) blast, no symptoms of PTSD were recorded.  However, the PTSD diagnosis was not considered by the physical evaluation board (PEB) and, therefore, an MH diagnosis was eliminated to the applicant’s possible disadvantage during that process.  Therefore, the applicant did appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project.

4.  The SRP agreed the preponderance of evidence at the time of separation did not support a PTSD diagnosis.  The applicant denied PTSD symptoms in the three Post-Deployment Health Assessment (PDHA) screens in evidence.  MH professionals and case management did not record PTSD symptoms in any of the encounters among the available service treatment record prior to separation. The SRP acknowledged the Department of Veterans Affairs (VA’s) granting of a PTSD with anxiety diagnosis; however, the SRP found insufficient evidence that the applicant ever met the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), diagnostic criteria for PTSD.  

5.  The SRP noted the VA examination recorded the applicant’s report of symptoms that were inconsistent with the treatment record.  The examiner clearly stated the applicant did not meet the full DSM IV criteria for PTSD, specifically, Criteria A and B were not met.  The diagnosis of anxiety disorder NOS was recorded by the treating psychologist, in the psychiatric memorandum prepared by the chief of psychiatry to the PEB, and at the VA Compensation and Pension (C&P) examination.  The SRP concluded the diagnosis of anxiety disorder NOS was the appropriate diagnosis at the time of separation.

6.  The SRP also considered whether the MH condition, regardless of specific diagnosis, was unfitting for continued military service.  The SRP agreed that evidence of the record reflected minimal MH-related symptoms; the applicant had minimal contact with MH.  He was prescribed antidepressant medication for reported mood symptoms and was noted to have variable response to the medication.  Mental status examinations were all essentially normal.  Although the applicant reported suicidal ideations, there were no recorded visits to the emergency room, no psychiatric hospitalizations, no suicidal attempts or gestures, and no evidence of occupational impairment (as related to mental functioning). The applicant concurred with the PEB findings.  The commander statement noted the applicant maintained a performance of excellence, and “even with his medical situation he showed no sign of not completing any and every task.” Recommendation was to retain the applicant.  Additionally, no MH condition was profiled. 

7.  After due deliberation in consideration of the preponderance of the evidence, the SRP concluded the evidence did not support an unfit determination for any mental health condition at the time of evaluation in the DES or prior to separation.

8.  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



3


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1

ABCMR Record of Proceedings (cont)                                  AR20140014546



2


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1