IN THE CASE OF:  	  

		BOARD DATE:  15 October 2014	  

		DOCKET NUMBER:  AR20140015783 


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.

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

2.  The SRP reviewed the records for evidence of inappropriate changes in
diagnosis of the MH condition during processing through the Disability Evaluation System (DES).  The available evidence of record showed the diagnoses of depression, adjustment disorder, and cognitive disorder not otherwise specified (NOS) were rendered during DES processing.  The depression was not listed on the medical evaluation board (MEB) or adjudicated by the physical evaluation board (PEB).  Therefore, an MH diagnosis was eliminated during that process, thus, the applicant did appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project. 

3.  The SRP noted the depression diagnosis was listed on the physical examination for the MEB (DD Form 2808), and recorded in the neurology narrative summary (NARSUM).  The SRP agreed the preponderance of evidence at the time of separation did not support a diagnosis of depression.  The applicant underwent two psychiatric evaluations and two neuropsychological evaluations; depression was not diagnosed.  Clinical documentation described depressed mood and symptoms commonly associated with depression; however, there was insufficient evidence that the symptoms met the diagnostic criteria for an Axis I diagnosis of depression.  Treatment records were consistent with an adjustment disorder diagnosis.  

4.  The SRP concluded the diagnosis of adjustment disorder with mixed disturbance of emotions and conduct, and cognitive disorder NOS were the appropriate diagnoses at the time of Temporary Disability Retired List (TDRL) entry.  The adjustment disorder was not a physical disability and was not ratable in accordance with (IAW) Department of Defense Instruction (DoDI) 1332.38.  The SRP agreed that the PEB adjudication of the unfitting cognitive disorder NOS was supported by the evidence and application of the provisions of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 were appropriately not applied at TDRL entry.  

5.  The SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 30 percent at time of placement on the TDRL.  The higher 50 percent rating was for occupational and social impairment with reduced reliability and productivity due to such symptoms as difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly-learned material, forgetting to complete tasks); impaired judgment and impaired abstract thinking.  Available treatment records at the time leading up to TDRL entry indicated that although the neuropsychological examiner noted there were residual permanent deficits in verbal learning and memory, in visual-spatial perception and planning, and in attention, the applicant’s cognitive symptoms had stabilized and subsequent improvement was expected to occur slowly over time.  

6.  The SRP noted that in the 12 months prior to TDRL entry there was no evidence of impairment in thinking or judgment, no evidence of legal issues as the result of aggressive/violent behaviors, or recent behavioral issues in the workplace.  Although neuropsychological evaluation recorded deficits in some areas of executive functioning and attention, the applicant worked part-time, performing administrative tasks in a medical environment, and was taking college courses.  There was no documented evidence of global cognitive deficit, disorientation, reliance on Global Positioning System (GPS) for travel, or visits to the emergency room due to confusion or other cognitive symptoms.  The applicant did not implicate cognitive issues in her appeal letter to the MEB.  The SRP concluded the evidence reflected the 30 percent disability rating at the time of TDRL entry was appropriate. 

7.  The SRP later considered the rating for TDRL removal.  At the TDRL psychiatry examination on 28 March 2007, approximately 22 months after TDRL placement, the applicant was engaged in social activities, and had worked briefly but could not continue due to multiple absences secondary to headaches.  The VA physician in August 2006 stated, “It was my opinion that she was not able to maintain any type of employment because of her chronic subjective daily headaches and extreme frequency of missing work secondary to the headaches.”  Her mental status examination was essentially normal.  There was no evidence of impairment in thinking or judgment; the psychiatrist noted there were no appreciable gross deficits in memory, cognition, attention, or concentration.  Her symptoms remained stable and were recorded as mild.  The SRP determined that the evidence did not support a higher rating than 30 percent.  



8.  After due deliberation in consideration of the preponderance of the evidence, and mindful of VASRD Section 4.3 (reasonable doubt), the SRP concluded that there was insufficient cause to recommend a change in the PEB adjudication for the MH condition at either TDRL entry or removal.

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



3


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1

ABCMR Record of Proceedings (cont)                                  AR20140015783



2


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1