IN THE CASE OF:  	  

		BOARD DATE:  12 May 2015	  

		DOCKET NUMBER:  AR20150005651 


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).

4.  The applicant also requests the awards of the National Defense Service Medal (NDSM), Global War on Terrorism Service Medal (GWOTSM), and the Overseas Service Ribbon (OSR). 

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 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 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.  

5.  The applicant's request for the service awards has already been considered by the ABCMR under case number AR20130003423.  The applicant was notified of the Board results on 6 November 2013.  

DISCUSSION AND CONCLUSIONS:

1.  After a comprehensive review of the applicant's case, the SRP recommended by majority vote that the applicant's prior determination be modified effective as of the date of his prior medical retirement. 

2.  The SRP reviewed the records for evidence of inappropriate changes in diagnosis of the applicant's MH condition during processing through the Disability Evaluation System (DES).  The evidence of the available records shows the diagnosis of bipolar disorder I as the only diagnosis rendered during processing through the DES.  The SRP agreed there were no inappropriate changes in diagnoses and therefore, determined that the MH diagnoses were not changed to the applicant's possible disadvantage in the disability evaluation.  Therefore, the applicant did not meet the inclusion criteria in the Terms of Reference of the MH Review Project.

3.  The SRP noted the evidence indicated diagnosis of bipolar disorder was the only diagnosis rendered during the pre-Temporary Disability Retired List (TDRL) DES process.  However, at the time of removal from TDRL the civilian evaluation utilized by the physical evaluation board (PEB) in its adjudication added a diagnosis of post-traumatic stress disorder (PTSD), which the PEB omitted.  Therefore, the SRP concluded the MH diagnoses were changed during the DES process and met the inclusion criteria in the Terms of Reference of the MH Review Project. 

4.  The SRP considered the appropriateness of the change in diagnosis.  It was noted that the TDRL re-evaluation examiner relied on claims that were not substantiated to be historically accurate; and even the examiner cautioned that the accuracy of the exam should not be assumed.  The SRP noted that there was no history to support a PTSD diagnosis and through multiple hospitalizations the diagnosis was not rendered.  Therefore, the SRP agreed the diagnosis of PTSD was not substantiated and the diagnosis of bipolar disorder was the only appropriate diagnosis.  The SRP also noted that the provisions of the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 (mental disorders due to traumatic stress) were appropriately not applied in this case.

5.  The SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 30 percent at the time of TDRL entry.  The next higher 50 percent rating was for "Occupational and social impairment, with reduced reliability and productivity;" and for 70 percent, "Occupational and social impairment, with  deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood."  

6.  The SRP also considered the narrative summary (NARSUM) exam (4 months prior to entry on TDRL) which described mental status examination (MSE) findings and a Global Assessment of Functioning (GAF) score suggesting mild to moderate impairment.  However, it was noted that this evaluation was only 2 months after a psychiatric hospitalization and that there were two hospitalizations during the preceding year in the setting of recurring episodes of serious paranoid delusions and manic symptoms.  

7.  The SRP debated how controlled and stable the condition actually was at the time of entry on TDRL, and if the "occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks" stipulation of the 30 percent rating accurately depicted the condition.  In this regard, it was also noted that the applicant was hospitalized during the year after entry on TDRL.  Ultimately, the SRP majority concluded that the evidence just elaborated was most accurately described by the 50 percent rating.

8.  The SRP later turned its attention to a rating recommendation at the time of removal from TDRL, and considered if a rating higher than the 70 percent assigned by the PEB was warranted.  The next higher 100 percent rating was for "Total occupational and social impairment.  The SRP considered that there was possibly one 100 percent threshold symptom (persistent delusions and hallucinations).  The applicant had no friends, and was withdrawn and socially isolated.  At the time of the TDRL re-evaluation exam, he expressed some difficulties with his supervisor, missed work days due to depression and was excessively tardy.  While he held a job since 2005, the month after the re-evaluation exam that was no longer the case.  Although by the applicant's report he managed his daily activities well, the subsequent supervisor's statement reflected significantly impaired occupational performance.  However, the SRP agreed that this evidence did not reflect the "total occupational and social impairment" stipulation of the 100 percent rating. 
9.  After due deliberation considering all of the evidence, and mindful of VASRD Section 4.3 (reasonable doubt), the SRP recommended a rating of 50 percent at the time of entry on TDRL and no change in the rating for the bipolar disorder condition at the time of medical retirement.

10.  The available evidence shows the SRP's assessment should be accepted.  

BOARD VOTE:

____X___  ____X___  ____X___ GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The Board determined that the evidence presented was sufficient to warrant a recommendation for relief.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by modifying the applicant's prior determination as indicated below:

UNFITTING CONDITION
VASRD CODE
TDRL RATING
PERMANENT RATING
Bipolar Disorder
9432
50%
70%

COMBINED
50%
70%



      _______ _   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)                                  AR20150005651



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