ADDENDUM TO 
RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF: 			DOCKET NUMBER: BC-2010-02701

						COUNSEL:  NONE

						HEARING DESIRED:  NO 

APPLICANT REQUESTS THAT:

He receive a permanent disability retirement with a disability rating of at least 30 percent for depression.

STATEMENT OF FACTS:

By DD Form 149, Application Correction of Military Record, dated 26 July 2010, the applicant requested his discharge with severance pay be reevaluated for a higher percentage or he receive a disability retirement.  On 7 February 2013, the Board considered and denied the applicant’s request noting there were no errors found in the applicant’s discharge processing.  The applicant’s medical condition was reviewed and rated in accordance with the applicable instructions and policy.  For an accounting of the facts and circumstances surrounding his request, and the rationale for the earlier decision by the Board, see the Record of Proceedings, with Exhibits A through I, at Exhibit J.

By DD Forms 149, dated 25 September 2015 and 15 January 2016, the applicant requests a higher rating for his depression and that he be permanently disability retired.  He states the higher ratings he received from the DVA in May 2010 and October 2013 were made effective the day after his date of discharge, which indicates he was more disabled at that time than originally rated by the Air Force.  He further states his personal desire to remain in Air Force and the recent loss of a child made him unwilling, at the time of his discharge, to fully appreciate the severity of his condition.

The applicant’s complete submission, with attachments, is at Exhibit K.

AIR FORCE EVALUATION:

The AFBCMR Medical Consultant empathizes with the applicant’s dilemma in trying to save his military career by possibly hiding what was truly happening to him, but after failing to succeed, was then left with the burden of losing his military career, unemployment, and the death of his child.  However, despite the stigma with seeking mental health care, it is the truthfulness of disclosures upon which the treating provider rely upon to direct treatment and make recommendations regarding an individual’s fitness to serve.  Indeed, the decisions of previous appellate boards were based upon the disclosures and evidence available at the “snapshot” time of the applicant’s military service; and not on a future assessment during which additional disclosures may be made or a condition may have worsened affecting employability.  While the service evidence to date has justified the conclusions reached by the IPEB, FPEB, and SAFPC, the Medical Consultant recommends obtaining a psychiatric evaluation from a psychiatrist or psychologist, in accordance with the National Defense Authorization Act (NDAA) 2015.  

The complete AFBCMR Medical Consultant evaluation is at Exhibit L.

The AFBCMR Psychiatric Consultant recommends granting the requested relief indicating there is evidence of an error or injustice. 

The multiple diagnoses the applicant has received range from a developmental - childhood illness such as Attention Deficit Hyperactivity Disorder (ADHD) to life-long pathological traits such as Personality Disorders (PD), and Dysthymia to episodic disabling conditions such as Major Depressive Disorder (MDD), Adjustment Disorder and Grief.  The complex interactions between all the above-mentioned conditions is beyond the scope of this advisory.  However, the Board is advised that diagnostic nomenclature assigned to a given set of psychiatric symptoms and stressors, as reported by a patient at a given point in time [during a military evaluation], not uncommonly may change over time; or may be reported differently at a subsequent point in time [e.g., post-service DVA Compensation & Pension evaluation].  For instance, the applicant’s self-disclosed underreporting of symptoms, motivated by the desire to be found fit for duty during the MEB process, as well as applicant’s potential exaggeration of problems during DVA evaluation could substantially contribute to the discrepancy between the rating agencies;  since with disclosure of a different clinical history or set of symptoms, a new mental health provider is more inclined to reach a different diagnostic/clinical conclusion, as was likely in the case under review.  

Furthermore, professional opinions may even vary between two different providers when given the same set of clinical symptoms from the same patient; and during the approximate same period of time and a change of clinical impression may legitimately occur following a greater period of observation and treatment; notwithstanding the fact that individuals may also experience symptoms that are shared [overlapped] by one or more other clinical diagnoses. For example, the applicant’s struggles with concentration could be a product of untreated ADHD, which would exacerbate at the times of stress and increased demands, or a symptom of depression.  His severe depressive symptoms with suicidal ideations, that would significantly improve only a short week later, could be indicative of the poor coping skills due to the Personality Disorder, Adjustment Disorder or Major Depression superimposed on Dysthymia.  

The DVA acknowledged this dilemma during their original rating decision on 3 February 2011 and stated the following “the attention deficit hyperactivity disorder (ADHD) also contributes moderately to a lack of concentration or focus, but has been aggravated by the depression”  and  “the VA examiner noted that you have previously been diagnosed with dysthymia, but during the evaluation you describe significant depressive symptoms, at which point you described onset of full major depressive episode and the depression fluctuated since then without full interepisode remissions. The dysthymia emerged before the major depressive episode.  The diagnosis might have been appropriate, but based on the examination it appears that your depression had been present to some degree or another since 2005, but with partial interepisode remissions resembling dysthymia.”  

As evident in this applicant’s case, two or more mental disorders [Axis I and/or Axis II diagnoses] may co-exist concurrently, as co-morbid mental disorders in the same subject, often times making it difficult or inappropriate to attempt to separate the two due to their close association and shared clinical features.  Thus, the fact that the applicant has been given a different compensation by the DVA is insufficient to invalidate the accuracy or appropriateness of the conclusions reached by equally competent military mental health authorities and the applicant’s commander who were most familiar with his expressed pattern of behavior at the time of his military service.

Consequently, the applicant’s third DVA claim, which was received in October 2013 and adjudicated in March 2014 granting him 100 percent service connected (SC) disability for MDD.  In contrast, the original DVA rating adjudicated in February 2011, utilizing applicant’s service treatment records and VA examination conducted in July 2010, assigned the applicant 30 percent for SC MDD, which is not drastically different from the Air Force final rating decision.  Given the complexity of the case, this Psychiatric Consultant is not surprised by the variation.  The contemporary Integrated Disability Evaluation System (IDES) bypasses this problem, by appointing DVA as a rating agency.  However, the systems were not joined until 2012, whereas the applicant’s discharge took place in 2010.  

Nevertheless, after the careful review of the applicant’s service treatment records and considering the probative value of the DVA rating decision, which was based upon evidence occurring within 12 months of the applicant’s discharge date, this Psychiatric Consultant is more inclined to agree with the DVA 30 percent rating.  This Consultant questions the validity of the applicant’s functional assessment in 2009-2010 time frame and finds it highly unlikely that after a loss of a child, the applicant would have mild level of impairment, specifically given his history of previous depressive episodes and pathological personality traits.

The Psychiatric Consultant recommends the applicant be medically retired with a disability rating of 30 percent.

The complete AFBCMR Psychiatric Consultant’s evaluation is at Exhibit M.

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

In further support of his appeal, the applicant responds that he concurs with the recommendation of the Psychiatric Consultant and requests the Board adopt the recommendation to medically retire him with a 30 percent rating.  Additionally, he was awarded the Nuclear Deterrence Operation Service Medal by administrative correction and would like it added to his DD Form 214.

The applicant’s complete response is at Exhibit O.  

THE BOARD CONCLUDES THAT:

In an earlier finding, the Board determined there was insufficient evidence to warrant any corrective action and recommended his requested relief be denied.  After thoroughly reviewing the additional documentation submitted in support of his appeal, to include his rebuttal and the evidence of record, in judging the merits of the case, we conclude sufficient relevant evidence has been presented to demonstrate the existence of an error or injustice.  We agree with the opinion and recommendation of the AFBMCR Psychiatric Consultant and adopt the rationale as the basis for our conclusion the applicant has been the victim of an injustice.  In this respect, we note the applicant was evaluated by the Department of Veterans Affairs (DVA) within 12 months of being separated from active duty and awarded a 30 percent disability rating for major depressive disorder (MDD).  We are persuaded that since this evaluation occurred within such a short period of his release from active duty, his medical conditions warranted the higher disability rating of 30 percent.  Regarding the applicant’s request for his awarded Nuclear Deterrence Operation Service Medal to be updated on a new DD Form 214, Certificate of Discharge or Release form Active Duty, we note he will be provided documentation showing his record has been amended to include the medal upon finalization of the administrative correction.  Therefore, we recommend the applicant's records be corrected as indicated below.  

THE BOARD RECOMMENDS THAT:

The pertinent military records of the Department of the Air Force relating to the APPLICANT be corrected to show that: 

	a.  On 26 May 2010, he was found unfit to perform the duties of his office, rank, grade or rating by reason of physical disability incurred while he was entitled to receive basic pay; that the disability was not due to intentional misconduct or willful neglect; that the disability was not incurred during a period of unauthorized absence; and that the disability was not the direct result of armed conflict or caused by an instrumentality of war.

	b.  On 27 May 2010, he was not discharged from active duty, but rather, effective 27 May 2010, his name was placed on the Permanent Disability Retired List with a disability rating of 30 percent due to a diagnosis of Depression, under Veterans Affairs Schedule for Rating Disabilities (VASRD) code 9433, rated at 30 percent.  

	c.  He made an election under the Survivor Benefit Plan as provided for by law or the Code of Federal Register.

The following members of the Board considered AFBCMR Docket Number BC-2010-02701 in Executive Sessions on 24 January 2017, 1 February 2017 and 23 March 2017, under the provisions of AFI 36-2603:

	, Panel Chair
	, Member
	, Member

All members voted to correct the records as recommended.  The following documentary evidence pertaining to AFBCMR Docket Number BC-2010-02701 was considered:

	Exhibit J.  Record of Proceedings dated 22 Apr 13,
            w/Exhibits.
	Exhibit K.  DD Forms 149, dated 30 Sep 15 and 21 Jan 16,
  w/atchs.
	Exhibit L.  Memorandum, AFBCMR Medical Consultant, dated 
  25 Mar 16.
	Exhibit M.  Memorandum, AFBCMR Psychiatric Consultant, dated
  21 Nov 16.
	Exhibit N.  Letter, SAF/MRBR, dated 1 Dec 16.
	Exhibit O.  Letter, Applicant, dated 29 Dec 16.

Pursuant to paragraph 1 of AFI 36-2603 (Title 32 Code of Federal Regulations, Part 865.1), it is certified that a quorum was present at the Board's review and deliberations, and that the foregoing is a true and complete record of the Board's proceedings in the above-entitled matter.