IN THE CASE OF:	  

		BOARD DATE:	  12 May 2015

		DOCKET NUMBER:  AR20150005644 


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 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 a MH 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 MH 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 in
diagnosis of the applicant's MH condition during processing through the pilot disability evaluation system (DES).  Diagnoses of post-traumatic stress disorder (PTSD) and attention deficit hyperactive disorder (ADHD) (Department of Veterans Affairs (VA)) were rendered during the DES process.  The SRP agreed that there were no inappropriate changes in diagnosis to the applicant’s possible disadvantage while processing through the DES.  Therefore, the applicant did not meet the inclusion criteria in the Terms of Reference of the MH Review Project.

3.  The SRP noted that the physical evaluation board (PEB) incorporated the diagnoses of ADHD and traumatic brain injury (TBI) into the PTSD rating, as recommended by the VA.  However, ADHD was not considered to be a physical disability and although TBI was considered to be medically acceptable, the SRP agreed that any MH symptoms present at the time of placement on Temporary Disability Retired List (TDRL) and at medical retirement that were a consequence of TBI are properly subsumed into a rating of the MH condition.  Any other TBI residuals, such as headaches, were outside the SRP’s scope of review.
The provisions of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 (mental disorders due to traumatic stress) were applied by the PEB as directed by Department of Defense (DoD) policy (placement on TDRL) with a minimum rating of 50 percent for a period of 6 months prior to reevaluation and re-adjudication.

4.  The SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at the time of placement on the TDRL.  The next 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 during the time leading up to TDRL entry recorded no history of suicidal attempts and no visits to the emergency room for panic attacks or other MH concerns.  The VA examiner stated that symptoms interfered “moderately” with functioning and assigned a Global Assessment of Functioning (GAF) score consistent with that assessment.  There was no evidence of 70 percent threshold symptoms such as suicidal ideation, obsessional rituals, illogical or irrelevant speech, spatial disorientation or neglect of personal appearance and hygiene.  The SRP concluded there was insufficient reasonable doubt (in accordance with (IAW) VASRD Section 4.3) for recommending the next higher 70 percent rating at the time of entry on TDRL.  

5.  The SRP later turned its attention to a rating recommendation at the time of removal from TDRL.  It was noted that during the TDRL period, the applicant was additionally diagnosed with major depressive disorder (MDD) and had two hospitalizations related to the depression.  The SRP carefully reviewed the evidence for a separate diagnosis of MDD and determined the diagnosis was appropriately rendered and appropriately adjudicated as a co-morbid condition.  

6.  The SRP also considered if there was evidence for a VASRD Section 4.130 rating higher than 70 percent at the time of TDRL exit.  The higher 100 percent rating was for “Total occupational and social impairment.”  The applicant reported he was unemployed since separation but was able to complete an Associate Of Arts (AA) degree in computer technology, was pursuing a Bachelor’s degree in the same area and attending classes 3 days per week.  He enjoyed several leisure activities, maintained his home, and enjoyed a friendship with a Warrior Transition Unit (WTU) buddy.  The TDRL re-evaluation examiner characterized his impairment as “deficiencies in most areas,” which did not support a 100 percent rating.  His mental status examination (MSE) recorded no 100 percent threshold symptoms such as gross impairment in thought processes, persistent delusions or hallucinations, grossly inappropriate behavior, or disorientation.  The SRP concluded that the evidence did not support a rating higher than 70 percent at the time of removal from TDRL.

7.  After due deliberation in consideration of the preponderance of the evidence, the SRP concluded, mindful of VASRD Section 4.3 (reasonable doubt), that there was insufficient cause to recommend a change in the PEB adjudication for the MH condition.

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)                                  AR20150005644



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