BOARD DATE:	  7 January 2015

		DOCKET NUMBER:  AR20140021607 


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 diagnosis of the MH condition during processing through the Integrated Disability Evaluation System (IDES).  The Department of Veterans Affairs (VA) rating decision indicated the diagnosis of anxiety disorder not otherwise specified (NOS) was a claimed condition and was not referred under the IDES.  The Narrative Summary (NARSUM) physician determined that no MH diagnosis should be listed on the Medical Evaluation Board (MEB).  The VA compensation and pension (C&P) evaluation recorded a diagnosis of anxiety disorder NOS with panic attacks. 

3.  The SRP noted that the Impartial Medical Review (IMR) recommended the VA diagnosis of anxiety disorder NOS with panic attacks be added to the MEB.  The Physical Evaluation Board (PEB) obtained a diagnostic variance that recommended no MH diagnosis be recorded for adjudication.  The SRP concluded an MH diagnosis was eliminated during that process.  Therefore, the applicant met the inclusion criteria in the Terms of Reference of the MH Review Project.

4.  The SRP agreed there was insufficient evidence at the time of separation to support a diagnosis of anxiety disorder NOS with panic attacks.  The SRP noted the absence of clinical documentation of panic attacks and the absence of anxiety symptoms unrelated to public speaking.  There was no indication that the IMR reviewer performed a clinical evaluation, and the self-reported symptoms of anxiety related to medical conditions and panic attacks recorded at the C&P mental evaluation were not recorded in any other clinical record.  However, based on the available clinical evidence the major focus of treatment appeared to have been largely in response to public speaking fears. 

5.  The SRP therefore considered whether the diagnostic criteria for performance anxiety (social phobia) were met, and concluded there was insufficient evidence that criterion C and E were met.  Criterion C requires that the person recognizes that the fear is excessive or unreasonable, that was neither stated nor demonstrated in the record in evidence.  Criterion E requires that the symptoms significantly interfere with normal routine and occupational functioning, which was not supported by the commander’s statement.

6.  The SRP acknowledged the VA examiner’s assessment of anxiety disorder NOS with panic attacks; however, the available clinical evidence was insufficient to support that the applicant fully met the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM) diagnostic criteria for anxiety disorder NOS.  The SRP acknowledged that the criteria does allow for a clinician to make the diagnosis based solely on opinion.  The applicant endorsed many more symptoms at the VA exam not recorded in any other clinical record.  However, there was not a preponderance of evidence of significant social impairment or clinically significant anxiety symptoms that interfered with occupational performance or social interactions.

7.  The SRP members agreed, although the applicant had anxiety symptoms related to public speaking, that his symptoms did not rise to the level of meeting any Axis I anxiety-related DSM-IV TR diagnosis based on criteria.  Therefore, the SRP concluded there was not a preponderance of evidence to support an MH diagnosis at the time of medical retirement.

8.  The SRP also considered whether any mental condition, regardless of specific diagnosis, was unfitting for continued military service.  The SRP agreed that evidence of the record reflected minimal MH-related symptoms.  Therefore, the SRP concluded that there was insufficient evidence that any MH condition rose to the level of being unfitting at the time of medical retirement and therefore none were subject to service disability rating.

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 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)                                  AR20140021607



2


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1