IN THE CASE OF:	  

		BOARD DATE:	  12 May 2015

		DOCKET NUMBER:  AR20150005870 


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 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 medical 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 Disability Evaluation System (DES).  The evidence of the available records shows a diagnosis of post-traumatic stress disorder (PTSD) was 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 that the application of Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.129 (mental disorders due to traumatic stress) was considered for all cases of service-connected psychiatric conditions resulting in separation.  In this case, the physical evaluation board (PEB) recognized the applicability of VASRD Section 4.129, which would ordinarily mandate a 6-month period of Temporary Disability Retired List (TDRL) with a minimum rating of 50 percent for the PTSD, followed by reevaluation and re-adjudication.  However, the PEB acknowledged that Department of Defense Instruction (DoDI) 1332.38 E7.2.1 stipulated permanent retirement (i.e. no period of TDRL) provided other unfitting, stable diagnoses unrelated to the mental disorder achieve a combined rating of 80 percent or higher.  The non-MH conditions in this case achieved a combined rating greater than 80 percent.  The SRP had no latitude to counter the PEB determination and would only consider the VASRD Section 4.130 impairment present at the time of medical retirement for a single rating recommendation.

4.  The SRP noted the PEB assessed the symptoms of cognitive disorder due to traumatic brain injury according to VASRD Section 4.124a criteria, and judged that a maximum rating of 70 percent was warranted for the facet of memory, attention, concentration and executive functions.  The SRP also noted that while mental symptoms were subsumed under cognitive disorder, the separate rating adjudicated by the PEB for PTSD was appropriate.  The Department of Veterans Affairs (VA) meanwhile did not rate cognitive disorder, but instead assigned a 50 percent rating for migraine headache as a post-concussive residual; and additionally rated PTSD at 50 percent.  

5.  The SRP deliberated if a rating higher than 30 percent for PTSD was warranted at the time of medical retirement.  The 50 percent rating was characterized by "occupational and social impairment with reduced reliability and productivity, while the next higher 70 percent rating required "occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood."  The narrative summary (NARSUM) examiner's characterization of the condition reflected the "reduced reliability and productivity" stipulation of the 50 percent rating; however, the SRP noted that there were no 50 percent threshold symptoms, and noted a Global Assessment of Functioning score which reflected mild symptoms or impairment.  Social functioning was characterized by some isolation and marital "bickering" but the applicant was still engaged with friends at the local fire house.

6.  The SRP considered occupational impairment, but debated the extent to which unemployment was a consequence of non-MH factors.  In this regard, the commander's statement highlighted a non-mental condition as the cause of observed difficulties at work.  It was also debated whether the absence of psychotropic medication in the treatment of PTSD reflected a less severe condition.  The SRP remained cognizant of the risk of pyramiding (assigning separate ratings for overlapping disabilities), which is prohibited under VASRD Section 4.14.  In the applicant's case, some mental symptoms (impairment of memory, attention and executive function) were responsible for the 70 percent rating of cognitive disorder and should not contribute to rating PTSD. 

7.  After due deliberation in consideration of the preponderance of the evidence, the SRP agreed the evidence could not be reconciled with the next higher 50 percent rating and a rating higher than 30 percent for the PTSD condition was not supported.

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)                                  AR20150005870



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