IN THE CASE OF:    

		BOARD DATE:  15 October 2014	  

		DOCKET NUMBER:  AR20140015809 


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 vote 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 military Disability Evaluation System (DES). The evidence of the available records show  diagnoses of anxiety disorder not otherwise specified (NOS) and Post-Traumatic Stress Disorder (PTSD) were rendered.  The SRP determined that an MH diagnosis was not changed to the applicant’s possible disadvantage in the disability evaluation.  Therefore, the applicant did not appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project. 

3.  The SRP noted the diagnosis of PTSD was recorded on the physical examination for the medical evaluation board (MEB) (DD Form 2808) without recorded PTSD symptoms.  The SRP acknowledged the Compensation and Pension (C&P) examiner’s assessment and diagnosis of PTSD; however, there was insufficient clinical evidence to support that the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, (DSM-IV) diagnostic criteria were met since there was no clear evidence in the service treatment record to support the applicant met the full criteria for a PTSD diagnosis at the time of Temporary Disability Retired List (TDRL) entry.  The applicant denied all PTSD related symptoms in the months after re-deployment.  The records noted several symptoms suggestive of PTSD; however, there was insufficient evidence that his symptoms rose to the level of PTSD. 

4.  The SRP noted that while the MEB physical documented a diagnosis of PTSD, the psychiatry narrative summary (NARSUM) very clearly demonstrated that DSM-IV diagnostic criteria were not met.  The SRP agreed that physical evaluation board (PEB) adjudication of unfitting anxiety disorder NOS was supported by the evidence and was the appropriate diagnosis.  The SRP noted the application of the provisions of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 were appropriately applied (mental disorders due to traumatic stress) for application at TDRL entry.  


5.  The SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at time of placement on the TDRL.  The higher 70 percent rating was for “Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.”  Available treatment records at the time leading up to TDRL entry recorded no history of suicidal ideation, no visits to the emergency room (ER) for his reported panic attacks, no psychiatric hospitalizations, and no evidence of impairment in judgment or thinking.  The SRP considered the record in evidence did not support a rating higher than 50 percent for 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 that at TDRL exit the diagnosis of PTSD was assessed and adjudicated by the PEB.  The applicant appeared to have met the full diagnostic criteria for PTSD.  The SRP agreed that PTSD was the appropriate diagnosis at TDRL exit.  At the time of permanent retirement, the SRP agreed that the record adequately demonstrated although, the applicant reported he was unemployed, had lost his daughter to an accident, had problems with anger, and felt sad and hopeless; there were no records of visits to the ER, panic attacks, psychiatric hospitalizations, and no reports of violence or legal issues.  There was no evidence of impairment in judgment or thinking.  The applicant maintained his marriage, was able to enjoy fishing and Bible study and remained in treatment.  His condition was stable and did not reflect a disability rating higher than the 50 percent disability rating criteria.

7.  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 TDRL entry or permanent retirement.

8.  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)                                  AR20140015809



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