IN THE CASE OF:	  

		BOARD DATE:	  15 October 2014

		DOCKET NUMBER:  AR20140015769 


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. He contends that the Department of Veterans Affairs (VA) diagnosed him with PTSD and awarded him a disability rating of 100 percent.

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 in the physical evaluation board (PEB) adjudication of the temporary disability and permanent retirement determination. 

2.  The SRP reviewed the records for evidence of inappropriate changes in the diagnosis of the MH condition during processing through the military Disability Evaluation System (DES).  The evidence of the available records shows diagnoses of anxiety disorder not otherwise specified (NOS), partner relational problems, personality disorder NOS, and Post-Traumatic Stress Disorder (PTSD) were rendered.  The SRP determined that an MH diagnoses was eliminated in the disability evaluation system.  Therefore, the applicant did appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project. 

3.  The SRP noted that PTSD was listed on the DD Form 2808 and was diagnosed at the Temporary Disability Retired List (TDRL) removal examination.  The SRP agreed that PEB adjudication of unfitting anxiety disorder NOS was supported by the evidence; there was insufficient documented evidence to support a diagnosis of PTSD prior to TDRL entry.  No treatment provider diagnosed PTSD.  PTSD was not diagnosed by the narrative summary (NARSUM) psychiatrist and was not diagnosed during psychological testing.  The SRP acknowledged the Compensation and Pension (C&P) examiner’s assessment of PTSD; however, it also noted inconsistencies in the applicant’s reporting of symptoms as related to stressors and events. 

4.  The SRP noted the record in evidence did not clearly demonstrate that the full Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, (DSM-IV-TR) diagnostic criteria for PTSD were met.  The applicant appeared to have met the DSM-IV TR diagnostic criteria for anxiety disorder NOS; therefore, the diagnosis of anxiety disorder NOS was the appropriate diagnosis and application of the provisions of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 was correctly not applied (Mental disorders due to traumatic stress).
5.  The SRP next considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent.  At the time leading up to TDRL placement, there was no clinical evidence of impairment in thinking, disturbance in thought processes, impaired communication ability, near-continuous panic or depression affecting the applicant’s ability to function independently, and no issues of self-neglect of personal appearance and hygiene.  The SRP agreed the record in evidence did not support a higher than 50 percent rating at TDRL entry and there was insufficient reasonable doubt (in accordance with (IAW) VASRD Section 4.3) for recommending a 70 percent TDRL entry rating. 

6.  The SRP noted the personality disorder was determined by the PEB to be a condition “not constituting a physical disability (lAW Department of Defense Instruction (DoDI) 1332.38, E5.1.3.9.2) and not ratable in the absence of an underlying causative disorder.”  The SRP noted the TDRL removal examination mental status examination (MSE) findings were inconsistent with the records and had elements of internal inconsistency.  For example, although the examiner reported the applicant was not oriented to any sphere the applicant reportedly had no difficulty with communication or speech, and judgment was recorded as intact.  The applicant reported he had persistently seen a figure of a child, even during the examination “he was seeing a child”; however, delusions were recorded as absent. 

7.  The SRP agreed at the time of permanent retirement that the record adequately demonstrated that the applicant’s condition had stabilized since TDRL entry.  He had no further hospitalizations, no recorded visits to the Emergency Room (ER) for MH concerns, the TDRL examiner noted the applicant had a good relationship with his wife but had difficulty understanding complex commands and memory issues; however, the examiner also stated his anxiety condition had stabilized and suicidal gestures were no longer present.  The examiner opined that there were social and occupational deficiencies in most areas, and assigned a Global Assessment of Functioning (GAF) of 35; however, this opinion was disparate with the general findings and the clinical evidence set forth in the examination.  The SRP concluded that there was insufficient cause to recommend a disability rating higher than the 50 percent granted. 

8.  After due deliberation in consideration of the 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 at permanent retirement.

9.  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)                                  AR20140015769



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