BOARD DATE:	  8 October 2014

		DOCKET NUMBER:  AR20140015303 


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 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 recommended that the applicant’s prior determination be modified to reflect a permanent rating of 50 percent rather than 30 percent for his Post-Traumatic Stress Disorder (PTSD) condition.

2.  The MH diagnosis of PTSD was not changed to the applicant’s disadvantage
during processing through the Disability Evaluation System (DES) and, therefore, the applicant’s case did not meet the inclusion criteria in the Terms of Reference of the MH Review Project.  

3.  The physical evaluation board (PEB) determined the PTSD condition was unfit, applied the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129, and placed the applicant on the Temporary Disability Retired List (TDRL) with a 50 percent disability rating.  At the time of permanent disability disposition and removal from the TDRL, the PEB rated the PTSD at 30 percent.  The SRP considered whether the evidence of record supported ratings for the unfitting PTSD condition at TDRL entry and TDRL exit that were higher than those adjudicated by the PEB.  The SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at time of placement on the TDRL.

4. The SRP noted that psychiatrist who wrote the addendum to the narrative summary (NARSUM) described Impairment for social/industrial adaptability as “Definite” with a Global Assessment of Functioning (GAF) in the moderate range.  There was no gross memory or thought process deficits.  The pre-TDRL entry exam documented similar PTSD symptoms with a GAF in the same moderate range with no impairment to thought processes.  Any psychiatric or cognitive symptoms from the applicant’s Traumatic Brain Injury (TBI) condition were also considered in the VASRD Section 4.130 rating, and alcohol use was conceded as related to the MH condition.  The SRP concluded that there was not sufficient evidence to support a VASRD Section 4.130 rating higher than the 50 percent required by application of VASRD Section 4.129 at entry onto the TDRL.



5.  The SRP noted that the most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case was the TDRL NARSUM performed in March 2011, 4 months prior to TDRL exit.  That examination described serious symptoms with a GAF of 45 (serious symptoms) and indications of an apportionment of symptoms between PTSD (70 percent) and personality disorder (30 percent).  Personality disorder was not noted to be a consistent diagnosis in prior or subsequent exams and the SRP discussed any potential decrease in PTSD rating under VASRD Section 4.130 due to any MH condition other than PTSD.  

6.  The SRP considered the examiner’s addendum indicated the VA records stating that the applicant was placed on high suicide risk and “has not recently been stable.”  Subsequent records indicated the applicant had legal involvement (probation) due to an assault in 2011 related to alcohol use (attributed to PTSD).  However, the month of the assault was not specified, and it was not possible to determine if this occurred prior to or after TDRL removal.  The SRP noted the VA exam 2 years after TDRL removal indicated total occupational impairment based principally on “grossly inappropriate and aggressive behavior and persistent danger of hurting self or others” but was too remote from TDRL removal to carry a high probative value for permanent rating outside the history that related to the TDRL-removal timeframe.  

7.  The SRP considered that the record at the time of TDRL removal indicated some level of instability that was not sufficiently high (at the preponderance of evidence level) to recommend prolongation of the assigned prior TDRL period.  The SRP agreed that the psychiatrist’s evaluation at the time, including a serious GAF, unemployment, very limited judgment, and chronic anxiety and irritability with other chronic PTSD symptoms was closer to the 50 percent disability description of occupational and social impairment with reduced reliability and productivity rather than the 30 percent description of occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.

8.  After due deliberation in consideration of the preponderance of the evidence, and with consideration of reasonable doubt (VASRD Section 4.3), the SRP concluded that there was insufficient cause to recommend a change in the PEB adjudication for TDRL entry, but that there was sufficient cause to recommend a permanent 50 percent rating at the end of TDRL for the applicant’s PTSD condition.

9.  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 the applicant’s prior determination to reflect a permanent rating of 50 percent rather than 30 percent for his PTSD condition.




      _________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)                                  AR20140015303



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