IN THE CASE OF:	   

		BOARD DATE:	  11 June 2015

		DOCKET NUMBER:  AR20150007873 


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 processing.

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 separation determination.

2.  The SRP considered the appropriateness of changes in MH diagnoses and the Physical Evaluation Board (PEB) fitness determination; if unfitting, whether the provisions of Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) section 4.129 were applicable; and a disability rating recommendation in accordance with VASRD section 4.130.  The SRP first considered whether there was a change in the MH diagnoses to the applicant’s possible disadvantage during Disability Evaluation System (DES) processing.  The SRP noted the diagnosis of anxiety disorder was noted on the profile and physical and not recorded at the Medical Evaluation Board (MEB) and subsequently not adjudicated by the PEB; therefore, this diagnosis was eliminated.  However, when the diagnosis of a non-specific anxiety disorder is made, the applicable category for such a condition is “Not otherwise specified (NOS),” and therefore, symptoms are either predominantly anxiety or a mix of depression and anxiety.

3.  The SRP concluded, due to the nature of the diagnosis and its likely relationship with dysthymia, that the applicant did not meet the inclusion criteria in the Terms of Reference of the MH Review Project.  The three MH diagnoses of major depressive disorder (MDD), dysthymic disorder, and eating disorder were maintained from the MEB through the final DES determination.  Anxiety disorder was a diagnosis before, during, and after the DES process; however, treatment documents in the record did not consistently differentiate between anxiety symptoms and a formal diagnosis of anxiety disorder.  Source diagnostic-level MH records were not in the record of evidence proximate to the DES timeframe.  The SRP determined that there was not a preponderance of the evidence to warrant a change in MH diagnoses to include anxiety disorder at the time of separation. 

4.  The SRP next deliberated fitness for each of the specific MH conditions and if there was permanent service aggravation of pre-existing conditions.  The SRP reviewed the PEB’s determination that eating disorder NOS was not unfitting.  The eating disorder was profiled, implicated in the commander’s statement (as anorexia nervosa), and was judged to fail retention standards with an existed prior to service (EPTS) determination at the MEB level.  The PEB determination was not unfitting and noted the applicant’s successful deployment and weight gain without significant health impairments.  

5.  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 fitness determination for the contended eating disorder NOS and so no additional disability rating can be recommended.  The SRP acknowledged the PEB’s adjudication of the not unfitting personality traits.  The narcissistic and obsessive compulsive personality traits were recorded on Axis II and did not rise to the level of a personality disorder proximate to DES adjudication. 

6.  The SRP discussed the nature of the applicant’s depression, evidence of EPTS, normal progression, what would constitute permanent aggravation and the level of evidence for determining the differences.  The PEB consolidated the two MH conditions and indicated that the MDD condition was consistent with the normal progression of dysthymic disorder.  The Diagnostic and Statistical Manual for Mental Disorders (4th Edition) (DSM-IV) indicates that in clinical settings 75 percent of individuals with dysthymic disorder will develop MDD within five years.  

7.  The SRP considered the applicant’s report that she had suffered from depressed mood most of her life, had prior treatment of anxiety and depression, had taken antidepressants, and had a past psychiatric history of suicidal thoughts.  The SRP concluded there was not sufficient evidence to support that the condition of MDD had not existed prior to service because there was insufficient evidence to support that the applicant’s reported history of depression was not due to a waxing and waning course of a single depressive condition. 

8. The SRP discussed the diagnostic criteria for both disorders and noted them to be in essence the same, separated only by two additional symptoms and the intermittent episodic nature that defines MDD.  Therefore, the SRP opined that the MDD condition was less likely than not caused by or was the result of service and was likely a progression of the dysthymic disorder condition.  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 EPTS without permanent service aggravation (not compensable) determination for the MDD with dysthymic disorder condition.

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



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ABCMR Record of Proceedings (cont)                                  AR20150007873



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