IN THE CASE OF:    

		BOARD DATE:  15 October 2014	  

		DOCKET NUMBER:  AR20140015772 


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 Department of Defense (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 an MH condition during processing through the military disability system.

2.  The DOD 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, 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 to the applicant's disability and 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 DD Form 2808 (Report of Medical Examination) listed diagnosis of “Depression and anxiety” and rule/out Post-Traumatic Stress Disorder (PTSD), the Temporary Disability Retired List (TDRL) entry narrative summary (NARSUM) and neuropsychological addendum diagnosed post-concussion syndrome.  The Medical Evaluation Board forwarded post-concussion syndrome/headaches and anxiety and depression as meeting retention standards.

3.  The SRP noted that the Physical Evaluation Board (PEB) adjudicated “Residuals of Traumatic Brain Injury (TBI)” “(post-concussion syndrome/headaches)” as unfitting and the anxiety and depression as not unfitting.  The TDRL removal psychological NARSUM diagnosed PTSD as a new diagnosis, resulting from the unfitting PEB diagnosis.  Therefore, the applicant did not meet the inclusion criteria in the Terms of Reference of the MH Review Project. 

4.  The SRP next considered if there was evidence in the record to support a recommendation of a diagnosis of PTSD, or any other MH condition, for disability rating at TDRL entry.  The SRP considered the criteria for a PTSD diagnosis according to the DSM-IV including: the evidence for the stressor (criterion A), re-experiencing of the event (criterion B), persistent avoidance of stimuli associated with the trauma (criterion C), hyperarousal (criterion D), duration and onset (criterion E), and presence of clinically significant distress or impairment in social, occupational or other important area of functioning (criterion F). 

5.  The SRP considered that the applicant had not been in treatment for a current MH diagnosis and was not diagnosed with PTSD prior to or during the DES process before TDRL entry.  The TDRL entry psychological NARSUM examiner noted that the applicant had PTSD and depression symptoms but did not meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for the diagnosis of any Axis 1 MH condition except post-concussion disorder not otherwise specified (NOS).  The neuropsychological addendum noted the applicant’s main issue was headaches. 

6.  The SRP acknowledged that the residuals of the TBI rating subsumed the MH symptoms that did not meet DSM-IV criteria for any specific MH condition noted by the TDRL entry psychiatrist and agreed that the applicant’s condition at TDRL entry was appropriately rated as TBI residuals in accordance with (IAW) Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) section 4.124a.  After due deliberation in consideration of the preponderance of the evidence, the SRP agreed that there was not sufficient evidence in the record to support recommending any MH condition for disability rating IAW VASRD section 4.130 at TDRL entry. 

7.  The SRP noted that during the TDRL period, the applicant was diagnosed with PTSD by his treating MH professionals and the TDRL removal psychiatric examiner agreed with the diagnosis.  The TDRL removal NARSUM indicated that the PTSD diagnosis was a new diagnosis that was a consequence of the TDRL entry diagnosis of TBI residuals.  The applicant was provided a permanent disability rating of 30 percent for the PTSD condition and the PEB indicated that VASRD section 4.129 did not apply because the MH condition was considered stable for rating purposes.

8.  The SRP considered whether VASRD section 4.129 was applicable in this case.  Based on the evidence in the available records, the applicant was diagnosed with PTSD in 2011, approximately 15 months after TDRL entry, and had been treated for PTSD for at least 21 months at the time of the TDRL removal evaluation.  A core intent of VASRD 4.129 is to provide for assessment and care of the service member through the stress of transition from military to civilian life.  The applicant had already been separated from the military for approximately 4 years at TDRL removal and the examiner indicated that the applicant was stable.  Therefore, the SRP agreed that the PEB decision to not apply VASRD section 4.129 was appropriate in this case. 

9.  The SRP turned to assessing the fairness of the separation rating for the PTSD diagnosis at TDRL removal based upon the evidence above.  The permanent disability rating IAW VASRD section 4.130 was 30 percent; therefore, the SRP focused on whether there was evidence to support the higher evaluation of 50 percent at permanent separation, specified as “occupational and social impairment with reduced reliability and productivity”; elaborating reference symptoms of flat affect; stereotyped speech; frequent (more than weekly) panic attacks; deficits in comprehension and memory; impaired judgment; mood disturbance; and difficulty with establishing relationships.
10.  The SRP agreed that the evidence in the record did not support a higher permanent rating than the 30 percent rating adjudicated by the PEB.  After due deliberation in consideration of the preponderance of the evidence, the SRP concluded that the PEB’s adjudication of a diagnosis of PTSD without application of VASRD section 4.129 at TDRL removal was appropriate, and there was not sufficient cause to recommend a change in the PEB rating of the MH condition at the time of permanent retirement. 

11.  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 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)                                  AR20140015772



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