RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2013-01627 COUNSEL: NONE HEARING DESIRED: NO _________________________________________________________________ APPLICANT REQUESTS THAT: 1. His medical discharge documents from the Air Force, DD Form 214, Certificate of Release or Discharge from Active Duty, and/or Permanent Disability Retired List (PDRL) be corrected to reflect his Post Traumatic Stress Disorder (PTSD). 2. His PTSD diagnosis be designated as a combat-related illness. _________________________________________________________________ APPLICANT CONTENDS THAT: He has documentation indicating his status as having PTSD and the Department of Veterans Affairs (DVA) has rated him as having PTSD. The applicant’s complete submission, with attachments, is at Exhibit A. _________________________________________________________________ STATEMENT OF FACTS: The applicant’s military personnel records indicate he enlisted in the Regular Air Force on 28 Dec 00. On 5 Sep 08, the applicant was relived from active duty with a narrative reason for separation of “Disability, Temporary” and was transferred to the Temporary Disability Retired List (TDRL). According to information provided by the applicant, on 30 Jun 09, the DVA reevaluated the applicant’s claim and retroactively upgraded his diagnosis of PTSD and increased his disability rating from 30 percent to 70 percent. On 12 Sep 12, as a result of his TDRL periodic re-evaluation, the applicant was removed from the TDRL and permanently retired with a combined compensable disability rating of 60 percent.The remaining relevant facts pertaining to this application are contained in the letters prepared by the appropriate offices of the Air Force, which are at Exhibits C and E. _________________________________________________________________ AIR FORCE EVALUATION: AFPC/DPFD recommends denial indicating there was no evidence of an error or injustice that occurred during the disability process. The applicant was diagnosed with a major depressive disorder associated with anxiety disorder, bilateral ankle and heel pain and chronic low back pain. The Informal Physical Evaluation Board (IPEB) recommended placing the applicant on the Temporary Disability Retired List (TDRL) with a combined disability rating of 60 percent, with his major depressive disorder rated at 30 percent. He concurred with the recommended findings and on 6 Sep 08 [sic], was discharged and transferred to the TDRL. On 2 Aug 10, during the applicant’s TDRL reevaluation, the IPEB recommended he be retained on the TDRL for bipolar disorder with a 50 percent rating, while his ratings for bilateral ankle and heel pain and chronic low back pain remained unchanged. On 25 Jun 12, during the applicant’s second TDRL reevaluation, the IPEB recommended he be removed from TDRL and permanently retired with a combined disability rating of 60 percent. The bipolar disorder and general medical condition was rated at 30 percent, bilateral ankle and heel pain at 21 percent, and the chronic low back pain at 20 percent. PTSD was not diagnosed from the original medical board and was not deemed combat related. The applicant concurred with the recommended findings and was removed from the TDRL, effective 12 Sep 12. The DoD and DVA disability evaluation systems operate under separate laws. Title 10 USC states that Physical Evaluation Boards (PEB) determine if a member’s condition renders them unfit for continued military service. A diagnosed medical condition does not necessarily mean that the condition is unfitting for continued military service. To be unfitting, the condition alone must preclude the member from fulfilling their military duties. The USAF disability boards must rate disabilities based on the member’s condition at the time of evaluation. The DVA picks up where the AF must, by law, leave off. Under Title 38 USC, the DVA determines and reevaluates service-connected conditions. Often times, the results are different ratings by the two agencies. A complete copy of the AFPC/DPFD evaluation is at Exhibit C. The AFBCMR Medical Consultant recommends denial indicating the applicant has not met the burden of proof of error or injustice that warrants the desired change of his record. The fact that the applicant was given a different diagnosis by the DVA provider is insufficient to invalidate the conclusions reached by competent military mental health authorities at the time of his military service. The diagnostic nomenclature assigned to a given set of psychiatric symptoms and stressors, as reported by a patient at a given point in time, may change over time, or may be reported differently at a subsequent point in time. Therefore, with disclosure of a different clinical history or set of symptoms, a new mental health provider is more inclined to reach a different diagnostic conclusion, as is likely in the applicant’s case. Professional diagnostic opinions may even vary between two different providers when given the same set of clinical symptoms from the same patient, given the fact that symptoms are often shared by one or more different clinical diagnoses (e.g., the depressed mood seen in Adjustment Disorder, Major Depressive Disorder, Dysthymic Disorder, Anxiety Disorder, PTSD, or secondary to Alcohol Dependence, and mood swings seen in Bipolar Disorder and Borderline Personality Disorder). Yet two or more mental disorders [Axis I and/or Axis II diagnoses] may even co-exist concurrently, often making it difficult to separate the two as individual functional entities due to their close association and shared clinical features (e.g., the applicant's initial diagnoses of Major Depressive Disorder associated with Anxiety Disorder). Thus, given the clinical symptoms recorded and conclusions reached at the applicant's military mental health evaluations, the fact that he has been given a different diagnosis by the DVA is insufficient to invalidate the accuracy or appropriateness of the conclusions reached by equally competent military mental health authorities, who were equally aware of the applicant's pattern of behavior reported at the time of his military service and TDRL assessment. According to DoDI 1332.38, Enclosure 3, Part 6, paragraph E3.P6.2.4.1, Compensability of New Diagnoses, conditions newly diagnosed during TDRL periodic physical examinations shall be compensable when: "The condition is unfitting" and, "the condition was caused by the condition for which the member was placed on the TDRL, or directly related to its treatment; or, "the evidence of record establishes that the condition was either incurred while the member was entitled to basic pay or as the proximate result of performing duty, whichever is applicable, and was an unfitting disability at the time the member was placed on the TDRL. Otherwise, such conditions shall be deemed unfitting due to the natural progression of the condition and noncompensable under Chapter 61 of 10 U.S.C., although the member may be eligible for benefits for these conditions under the Office of Veterans Affairs (OVA)." The applicant’s diagnosis of PTSD was not an unfitting condition at the time he was released from service and placed on the TDRL, nor was it caused by the condition for which he was placed on the TDRL. A complete copy of the AFBCMR Medical Consultant’s evaluation is at Exhibit D. _________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: Copies of the Air Force and AFBCMR Medical Consultant evaluations were forwarded to the applicant on 8 Aug 13 for review and comment within 30 days. As of this date, no response has been received by this office (Exhibit E). __________________________________________________________________ THE BOARD CONCLUDES THAT: 1. The applicant has exhausted all remedies provided by existing law or regulations. 2. The application was timely filed. 3. Insufficient relevant evidence has been presented to demonstrate the existence of an error or injustice. We took notice of the applicant’s complete submission in judging the merits of the case; however, we agree with the opinions and recommendations of the Air Force office of primary responsibility (OPR) and BCMR Medical Consultant adopt their rationale as the basis for our conclusion the applicant has not been the victim of an error or injustice. The applicant’s contentions are duly noted; however, we do not find these assertions, in and by themselves, sufficiently persuasive to override the evidence of record or the rationale provided by the noted advisory opinions. As for the applicant’s request that his PTSD be deemed a combat related disability, in view of the fact that we are not convinced that his PTSD was unfitting at the time of his discharge, there is no basis for us to conclude that his PTSD should have been found to be combat related. Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting the relief sought in this application. _________________________________________________________________ THE BOARD DETERMINES THAT: The applicant be notified the evidence presented did not demonstrate the existence of material error or injustice; the application was denied without a personal appearance; and the application will only be reconsidered upon the submission of newly discovered relevant evidence not considered with this application. _________________________________________________________________ The following members of the Board considered AFBCMR Docket Number BC-2013-01627 in Executive Session on 23 Jan 14, under the provisions of AFI 36-2603: , Panel Chair , Member , Member The following documentary evidence was considered: Exhibit A. DD Form 149, dated 19 Mar 13, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AFPC/DPFD, dated 30 May 13. Exhibit D. Letter, AFBMCR Medical Consultant, dated 7 Aug 13. Exhibit E. Letter, SAF/MRBRC, dated 8 Aug 13. 5 6