IN THE CASE OF:	

		BOARD DATE:	  15 October 2014

		DOCKET NUMBER:  AR20140015771 


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 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 be no change of the applicant’s disability and retirement determination. 

2.  The SRP reviewed the records for evidence of inappropriate changes or elimination of MH diagnoses to the possible disadvantage of the applicant during processing through the Disability Evaluation System (DES).  The evidence of the available records shows the diagnosis of major depressive disorder (MDD) with symptoms of Post-Traumatic Stress Disorder (PTSD) as the only diagnosis rendered during processing through the DES.  Therefore, the applicant did not appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project. 

3.  The SRP considered the report of PTSD symptoms to determine if a separate diagnosis of PTSD was warranted.  Careful review of the records in evidence demonstrated the report of trauma exposure and several other symptoms suggestive of PTSD; however, there was insufficient evidence that the full Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) 
diagnostic criteria were met for PTSD.  The SRP concluded the notation that the applicant had symptoms of PTSD was sufficiently captured by the diagnosis of combat related MDD.  The SRP acknowledged the diagnosis of PTSD by the Department of Veterans Affairs (VA) examiner 10 months after Temporary Disability Retired List (TDRL) placement; however, that examination did not clearly demonstrate that the full diagnostic criteria for PTSD were met.  The applicant was not diagnosed with PTSD prior to TDRL entry, did not meet criteria for PTSD at TDRL exit, and the TDRL examiner noted his VA treating psychiatrist
recorded MDD in partial remission as the only diagnosis. 

4.  The SRP agreed that physical evaluation board (PEB) adjudication of unfitting MDD was well supported by the evidence.  The applicant appeared to have met the DSM-IV TR diagnostic criteria for MDD; therefore, the diagnosis of MDD was the appropriate diagnosis and application of the provisions of the VA Schedule for Rating Disabilities (VASRD) Section 4.129 was correct (Mental disorders due to traumatic stress) for application at TDRL entry.  The SRP then considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at time of TDRL entry.  Although he had two hospitalizations, none occurred in the 10 months prior to TDRL entry.  There were no legal issues, no domestic violence, no history of panic attacks, and no evidence of impairment in thinking or judgement.  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 (in accordance with (IAW) VASRD Section 4.3) for recommending a 70 percent TDRL entry rating. 

5.  The SRP next considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at the time of TDRL exit.  The SRP agreed at the time of TDRL exit (permanent retirement) that the record adequately
demonstrated the applicant continued to exhibit mood symptoms consistent with his diagnosis of MDD and that his condition had not significantly improved. Although the applicant reported his depressive symptoms had worsened, the TDRL psychiatrist noted the treating psychiatrist had deemed his condition to be in partial remission, which strongly suggests improvement.  There was one hospitalization during the TDRL period for suicidal thoughts.  The applicant had not worked and engaged in limited activities outside of the home.  His mental status examination (MSE) was essentially normal and his Global Assessment of Functioning (GAF) had improved slightly from previously recorded GAFs.  His wife died from her illness in 2010; however, he noted good relationships with family members and indicated they had been a good source of support.  There was no report of legal problems, no frequent visits to the Emergency Room (ER), and no reported panic attacks.  Although the applicant stated he had not sought employment due to his MH symptoms, there was insufficient evidence that he was not employable.  The TDRL psychiatrist opined his MH condition resulted in reduced reliability and productivity.  His symptoms reflected the criteria for the 50 percent disability rating.

6.  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 for the applicant’s mental health conditions at the time of permanent retirement.

7.  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)                                  AR20140015771



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