BOARD DATE:	  1 October 2014

		DOCKET NUMBER:  AR20140015294 


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 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 recommended by unanimous vote no change in the applicant’s unfitting condition diagnosis and that her prior separation be modified to reflect a Temporary Disability Retired List (TDRL) rating of 70 percent for her MH condition, with a combined rating of 80 percent; followed by a permanent rating of 50 percent for her MH condition, with a combined permanent rating of 70 percent.

2.  The SRP reviewed the records for evidence of inappropriate changes in
diagnosis of the applicant's MH condition during processing through the Disability Evaluation System (DES).  The evidence of the available records show a diagnosis of Post-Traumatic Stress Disorder (PTSD) was rendered and the SRP agreed there was no change in that diagnosis; therefore, the applicant’s case did not meet the inclusion criteria in the Terms of Reference of the MH Review Project.

3.  The SRP noted the physical evaluation board’s (PEB’s) adjudication appropriately applied Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 and granted a TDRL entry rating of 50 percent for the PTSD with major depression condition.

4.  The SRP reviewed the entire record for evidence that a rating greater that 50 percent should have been granted at TDRL entrance.  The applicant manifested the occupational and social impairment, with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood as required for the 70 percent rating under VASRD Section 4.130.  The applicant was hospitalized twice for suicide attempts, and during the second hospitalization she attempted suicide.  Because of the severity of her depression and the constant suicide ideations and three attempts, she required six electroconvulsive shock treatments.  The applicant was discharged from the second hospitalization with a Global Assessment of Functioning (GAF) of 30- and inability to function in almost all areas. 

5.  The SRP noted that at the VA Compensation and Pension (C&P) exam, the applicant continued to have feelings of worthlessness, markedly diminished interest or pleasure with activities, recurrent thoughts of death, and admitted to homicidal thoughts.  

6.  The SRP agreed that the preponderance of evidence supported a TDRL entry rating criteria of 70 percent rating at entry into TDRL.  At TDRL removal, the PEB applied VASRD Section 4.130 to the PTSD and rated at 10 percent.  The PEB adjudication document contained the following statement:  “However, examiner also opined that at least 50 percent of Soldier's symptoms were attributed to her Borderline Personality Disorder, which was non-compensable.  Therefore, Soldier's rating was dropped from 30 percent to 10 percent.  Rated 10 percent and stable for a final rating.”

7.  The SRP agreed that it was impossible to clinically dissect the psychiatric impairment into ratable and unratable origins.  Both Department of Defense Instruction (DoDI) 1332.38 (E2.1.1) and the VASRD (Section 4.22) required a degree of certainty for justifying such deductions that was not achievable in this case without undue speculation.  The SRP agreed that its recommendation should concede the total VASRD Section 4.130 impairment in evidence as subject to rating.  

8.  The SRP noted the medical evaluation board (MEB) psychiatric narrative summary (NARSUM), which provided the most comprehensive psychiatric evaluation, found the applicant to have substantial periods of depressed mood with hopelessness, helplessness, suicidal ideation, negative thinking, long periods of psychomotor retardation, daily intrusive memories, images of childhood and military stressful events, avoidance symptoms, hyper-arousal symptoms, and difficulty with concentration and hyper-vigilance.  The applicant was noted to have a GAF of 55 which showed a moderate difficulty in social, occupational or school functioning.   The SRP adjudged the applicant’s symptomatology more closely approximated the 50 percent rating due to her social isolation, unemployed status and poor memory along with her depressed mood, anxiety, suspiciousness, and chronic sleep impairment.

9.  After due deliberation in consideration of the preponderance of the evidence, and mindful of VASRD Section4.3 (reasonable doubt), the SRP agreed that the evidence supported a TDRL removal rating of 50 percent.

10.  The available evidence shows the SRP’s assessment should be accepted.  

BOARD VOTE:

__x______  ___x_____  __x___  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION
BOARD DETERMINATION/RECOMMENDATION:

The Board determined that the evidence presented was sufficient to warrant a recommendation for relief.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by modifying her separation to reflect a TDRL rating of 70 percent for her MH condition, with a combined rating of 80 percent; followed by a permanent rating of 50 percent for her MH condition, with a combined permanent rating of 70 percent.



      __________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)                                  AR20140015294



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