IN THE CASE OF:
BOARD DATE: 28 July 2015
DOCKET NUMBER: AR20150010474
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 applicants 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.
DISCUSSION AND CONCLUSIONS:
1. After a comprehensive review of the applicants case, the SRP determined by unanimous vote that there be no change of the applicants disability and separation determination.
2. The SRP reviewed the records for evidence of inappropriate changes in diagnosis of the MH condition during processing through the Disability Evaluation System (DES). The available records show that the diagnoses of mood disorder due to general medical condition (Huntington's Disease [HD]), and depression were rendered during DES processing. The SRP noted the diagnosis of depression rendered during the neurology narrative summary (NARSUM) was not recorded on the Medical Evaluation Board, nor adjudicated by the Physical Evaluation Board (PEB). The SRP therefore concluded a diagnosis was eliminated to the applicants possible disadvantage while processing through the DES. The SRP determined the criteria for the Terms of Reference for the MH Review Project was met.
3. The SRP acknowledged the assessment by neurology and a letter generated by the Chief of Psychiatry that the applicant had a depression diagnosis independent of his neurological condition; however, there was insufficient evidence to support that full Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), diagnostic criteria for depression was met. DSM-IV required evidence that psychological symptoms were not due to a general medical condition; the available evidence did not satisfy that requirement.
4. The SRPs main charge with respect to its recommendation was an assessment of the fairness of the PEBs determination that there was no permanent service aggravation of the existed prior to service (EPTS) determination in regards to the HD condition and that the MH condition of a mood disorder was not a separate unfitting condition, and therefore eligible for a disability rating. The SRPs threshold for countering such determinations was higher than the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.3 (reasonable doubt) standard used for its rating recommendations, but remained adherent to the Department of Defense Instruction (DoDI) 6040.44 fair and equitable standard.
5. The SRP determined that a presumption of service aggravation would only be overcome by a preponderance of medical evidence that the natural progression of the pre-existing HD condition was unaltered by any consequence of military service. HD is a genetic disorder that causes the progressive degeneration of nerve cells in the brain. Signs and symptoms usually do not develop before the age of 30, and once significantly symptomatic, life expectancy is greatly reduced. HD has both cognitive symptoms and psychiatric symptoms; mood symptoms that were most prevalent. The evidence was clear. This condition by nature of genetics, EPTS, and by nature of the disease process, was not possibly aggravated by service. Since mood disorders were part of the expression of the disease, and too, a part of the disease process, its presence was expected, and not of an independent or separate origin, an observation made by both the Department of Veterans Affairs (VA) and NARSUM examiner. Therefore, the SRP concluded there was insufficient evidence to support that any MH condition was separately unfitting at the time of separation.
6. After due deliberation in consideration of the preponderance of the evidence, the SRP agreed that there was insufficient cause to recommend a change in the PEBs determination that the HD condition EPTS and was not permanently aggravated by service and that the mood disorder was appropriately subsumed under the primary condition and was not subject to Service disability compensation.
7. The available evidence shows the SRPs 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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ARMY BOARD FOR CORRECTION OF MILITARY RECORDS
RECORD OF PROCEEDINGS
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ABCMR Record of Proceedings (cont) AR20150010474
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