BOARD DATE:	  8 October 2014

		DOCKET NUMBER:  AR20140015308 


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 by unanimous vote that the applicant’s records be corrected to reflect that he was constructively placed on the Temporary Disability Retired List (TDRL) for a period of 6 months, with a rating of 50 percent for his anxiety disorder condition and a combined rating of 60 percent.  The SRP further recommended no change to the prior permanent disability determination.

2.  The SRP reviewed the records for evidence of inappropriate changes in
diagnosis of the applicant's MH condition during processing through the Integrated Disability Evaluation System (IDES).  Diagnoses of Post-Traumatic Stress Disorder (PTSD), major depressive disorder (MDD) (Department of Veterans Affairs (VA)), and anxiety disorder (medical evaluation board (MEB)) were rendered during the IDES process.  The diagnoses of PTSD and MDD were not forwarded by the MEB.  

3.  The SRP noted the change in diagnosis from anxiety disorder not otherwise specified (NOS) to factitious disorder during the TDRL.  The SRP agreed the applicant appeared to meet the inclusion criteria in the Terms of Reference of the MH Review Project.

4.  The SRP agreed the physical evaluation board (PEB) adjudication of unfitting anxiety disorder NOS was supported by the evidence.  The SRP in compliance with the provisions of the VA Schedule for Rating Disabilities (VASRD) Section 4.129 (mental disorders due to traumatic stress) noted the provision was applicable in this case and, therefore, must assign a disability rating of not less than 50 percent for an initial period of 6 months following separation, with subsequent fitness and ratings based on the applicable evidence. 

5.  The SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at the time of TDRL entry.  The higher 70 percent rating was for “Occupational and social impairment, with deficiencies in most areas.”  There was no evidence in the record of recurrent suicidal behaviors, no visits to the emergency room for MH treatment, no recurrent psychiatric hospitalizations, and no impairment in judgment.  He demonstrated no abnormalities of speech, panic attacks did not occur more than once/week, intact abstract thinking, intact long-term memory, and judgment was intact.  The commander noted the applicant’s medication interfered with his concentration and contributed to his short temper and outbursts, noting that he had some problems with communication and civil relationships with supervisors and other workers and he had difficulty with completing tasks.  The applicant was able to become engaged, enjoyed some recreational activities and tried to restart his tree service business by handing out business cards and placing an advertisement in the paper.

6.  The SRP concluded the record in evidence did not support a higher than 50 percent rating at TDRL entry and there was insufficient reasonable doubt for recommending a 70 percent TDRL entry rating.  At the time of TDRL psychiatric evaluation dated 12 April 2010, the applicant reported he was employed full-time, was married, enjoying his daughter, passing his correspondence course and not requiring psychotropic medication.  There was no reported history of suicidal or homicidal thoughts, plan, intent or attempts at any time.  There was no indication of a pattern of continued alcohol abuse.  There was no report of legal problems.  There was no report of domestic violence or violence outside of the home.  The applicant’s mental status examination (MSE) recorded an angry mood and irritable affect; however, there was no evidence of impairment in judgment, psychosis or issues in orientation or hygiene. 

7.  The SRP noted the change in diagnosis from anxiety disorder NOS to factitious disorder during TDRL and that the diagnosis of factitious disorder was based on the interpretation of neuropsychological testing by two neuropsychologists.  The examiners independently opined that there was reporting of significant psychiatric, cognitive and physical impairment, but that the psychological testing Minnesota Multiphasic Personality Inventory (MMPI-2) profile was invalid and uninterpretable due to clear exaggeration or feigning of psychopathology.  The examiners further opined that the factious disorder met retention standards.  The SRP concluded that factitious disorder was a new diagnosis introduced during TDRL and, therefore, not subject to a disability rating.  The SRP agreed the PEB adjudicated the factitious disorder appropriately as not ratable because it did not constitute a physical disability and was not ratable in accordance with (IAW) Department of Defense Instruction (DoDI) 1332.38.

8.  After due deliberation, in consideration of the preponderance of the evidence, the SRP concluded that neither the anxiety disorder NOS nor any other MH condition rose to the level of being unfitting at the time of separation and none were subject to disability rating.

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 to reflect he was constructively placed on the TDRL for a period of 6 months, with a rating of 50 percent for his anxiety disorder condition and a combined rating of 60 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)                                  AR20140015308



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