IN THE CASE OF: BOARD DATE: 5 May 2016 DOCKET NUMBER: AR20140020516 BOARD VOTE: _________ _______ ________ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ____X___ ____X___ ____X___ DENY APPLICATION 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration IN THE CASE OF: BOARD DATE: 5 May 2016 DOCKET NUMBER: AR20140020516 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 to amend the decision of the ABCMR set forth in Docket Number AR20140013484 on 10 September 2014. ____________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. IN THE CASE OF: BOARD DATE: 5 May 2016 DOCKET NUMBER: AR20140020516 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 reconsideration of his earlier request for a review of the military disability evaluation of his mental health condition. 2. The applicant states the error or injustice in his records relate to post-traumatic stress disorder (PTSD), depressive disorder, and anxiety disorder. He discusses his experience with suicidal thoughts. In effect, he wants a review of the level of impairment associated with specific symptoms (suicidal thoughts), which would impact his rating by the Department of Veterans Affairs (VA). 3. The applicant provides his VA progress notes. CONSIDERATION OF EVIDENCE: 1. Incorporated herein by reference are military records, which the Board summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in Docket Number AR20140013484 on 10 September 2014. 2. The applicant provides a new argument and/or VA progress notes in relation to his MH condition(s). 3. The applicant enlisted in the Regular Army on 19 August 2003 and held military occupational specialty 92G (Food Service Specialist). He served through multiple reenlistments in a variety of assignments, including Kuwait/Iraq: * from 27 October 2005 to 11 October 2006 * from 8 December 2007 to 23 February 2009 * from 26 June 2010 to 18 June 2011 4. On 23 July 2012, a medical evaluation board (MEB) convened and, after consideration of clinical records, laboratory findings, and physical examinations, the MEB found the applicant was diagnosed with the below conditions and recommended his referral to a physical evaluation board (PEB). Diagnosis Met Retention Standards Did Not Meet Retention Standards 1. PTSD X 2. major Depressive Disorder X 3. Dermatophytosis tinea pedis bilateral feet X 4. Migraine headaches X 5. Hypertension under control X 6. Bilateral pes planus X 7. Planter fasciitis X 8. Post-operative left knee anterior cruciate X 9. Alcohol abuse in early remission X 5. After counseling, the applicant indicated he reviewed the contents of the MEB and agreed with the findings and recommendations. 6. 11 October 2012, an informal PEB convened and found his condition(s) prevented him from performing the duties required of his grade and military specialty and determined that he was physically unfit due to PTSD with Major Depressive Disorder. a. The PEB noted that the behavioral health examiner attributes the Soldier’s condition to combat stressors. It has not responded sufficiently to multiple treatments. This condition is unfitting because the symptoms of depression, distrustfulness, and combat-related guilt interfere with the Soldier’s ability to perform common Soldier tasks, such as carrying and firing his individually assigned weapon. b. The PEB rated his condition at 50 percent and recommended placement on the Temporary Disability Retired List (TDRL) because the Soldier’s disability is not sufficiently stable for final adjudication from a disability percentage perspective. This is not a permanent rating or retirement. The disposition of his disability rating and retirement status can change when the case is finalized and the Soldier is removed from the TDRL. c. He received counseling and concurred. 7. The Army retired on 7 February 2013 and placed him on the TDRL in the rank/grade of sergeant (SGT)/E-5 due to temporary disability on 8 February 2013. The authority for this retirement is Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation), chapter 4. His DD Form 214 listed completion of 9 years, 5 months, and 15 days of active service. 8. In August 2014, he petitioned the Physical Disability Board of Review (PDBR) Special Review Panel for a review of his MH. The SRP reviewed his service medical records as well as his VA medical records and recommended no change to the PEB adjudication of the TDRL determination. 9. On 10 September 2014, the Board accepted the SRP’s findings and recommendations and denied the applicant any change in his TDRL determination. 10. On 16 February 2015, a TDRL PEB convened. It noted that his PTSD continued to be unfitting. However, this condition is considered stable for rating and is rated for occupational and social impairment with deficiencies in most areas of life (work, school, mood, thinking and judgment) due to the following symptoms: suicidal ideation, near-continuous panic or depression, and difficulty in adapting to stressful circumstances. The TDRL PEB recommended a rating of 70 percent and permanent retirement. 11. On 25 February 2015, the U.S. Physical Disability Agency (USAPDA) published orders removing him from the TDRL and permanently retiring him at a disability rating of 70 percent. 12. He now provides additional VA progress notes. The Board forwarded his new evidence to the Office of the Surgeon General for an advisory opinion. An official/clinical psychologist of the Regional Health Command-Central rendered an advisory opinion on 14 March 2016. He stated: a. He reviewed the applicant’s application; his correspondence, dated 30 October 2014; the PDBR SRP recommendation, dated 1 August 2014; Request and Consent for Release of information, dated 8 May 2013; and the applicant’s DD Form 214. He also reviewed the memorandum from William Beaumont Army Medical Center to the applicant, dated 22 May 2012; the applicant’s electronic medical records (also known as AHLTA), from 4 April 2005 to 26 February 2016; and the Alternatives Center for Behavioral Health Medical Records, from 9 August 2012 to 11 September 2012. He further reviewed his VA medical records from 15 February 2013 - 29 July 2014. b. He identifies the error or injustice in his record as "PTSD, depressive disorder anxiety disorder." His correspondence discusses his experience of suicidal thoughts. Based on available information, it appears that he is requesting review of his diagnosis of record and level of impairment associated with specific symptoms (i.e. suicidal thougl1ts), which would affect his VA rating. c. The records indicate he was medically retired from the U.S. Army and placed on the TDRL in October 2012, with the following unfitting and unstable behavioral health conditions: PTSD and Major Depressive Disorder. AHLTA records support the presence of PTSD and Major Depressive Disorder through 2012, when the Army placed him on the TDRL, and discontinued receiving BH services on-post. Subsequent AHLTA records (2015 and 2016) address only physical health issues, which is outside of the scope of this review. Records from the VA between 2013 and 2014 initially document both diagnoses; however, the diagnosis of Major Depressive Disorder does not appear in records after February 2013. After that encounter, the only diagnosis noted as comorbid with PTSD is Alcohol Use Disorder, Moderate (with lapses reported periodically throughout records). His available VA records describe his mood as stable and he reports attending school and working, although he continues to present with PTSD symptoms. On 20 December 2013, he reported a history of suicidal ideation without plan or intent, but no current suicidal ideation. In all previous and subsequent VA encounters, he consistently has denied suicidal or homicidal ideation. During the last VA encounter available, on 25 July 2014, he reported improvement in PTSD symptoms following Prolonged Exposure, discussing specifically decreased nightmares and anger, although he also reported a recent alcohol lapse. d. Based on available information, the behavioral health diagnoses of record found by the PEB and rated by the VA at the time of his separation from the Army are consistent with his treatment records at that time. Further, it appears that his symptoms have improved since placement on TDRL, and the VA discontinued the diagnosis of “Major Depressive Disorder” (although there are no more recent records from 2015 or 2016). This information suggests there were no additional diagnoses overlooked during the medical evaluation board (MEB) process. His question regarding proper consideration being given to his experience of suicidal ideation appears to be related to severity of impairment and VA ratings while on TDRL. However, reviewing his VA ratings is outside the purview of the Board and the USAPDA and PEB are the appropriate avenue to handle this issue. There were no information regarding his participation in the required periodic reevaluations while on TDRL. That would be his best venue for addressing rating concerns. e. There is no recommendation for correction to his military record. 11. The Board provided the applicant with a copy of this advisory opinion for review and submittal of a rebuttal. He did not respond. REFERENCES: A DOD memorandum, dated 27 February 2013, directed the Service Secretaries to conduct a review of mental health diagnosis for service members completing a disability evaluation process between 11 September 2001 and 30 April 2012 in order to determine if they were disadvantaged by a changed diagnosis over the course of their physical disability process. DISCUSSION: 1. The Army separated the applicant on 7 February 2013 and placed him on the TDRL due to his PTSD with major Depressive Disorder. The SRP considered if there had been any changes in the applicant’s mental health diagnosis and determined that the records consistently documented his PTSD throughout the applicant’s processing. He was not disadvantaged. 2. The SRP considered the rating of 50 percent assigned for the applicant’s unfitting PTSD at the time of his placement on the TDRL and determined there was insufficient evidence to support a higher rating. The SRP recommended no change to his rating. 3. The applicant now provides his VA progress notes with his application. An OTSG clinical psychologist reviewed his electronic medical records as well as his VA medical records and determined that the diagnosis of Major Depressive Disorder does not appear in his records after February 2013. The only diagnosis noted as related to his PTSD is Alcohol Use Disorder. His VA medical records also noted that in December 2013, he reported a history of suicidal ideation without plan or intent. However, he currently has none and in all previous and subsequent VA encounters, he consistently denied suicidal or homicidal ideation. 4. Based on the available information, the behavioral health diagnoses of record found by the PEB and rated by the VA at the time of his separation from the Army are consistent with his treatment records at that time. Further, it appears that his symptoms have improved since placement on TDRL, and the VA discontinued the diagnosis of “Major Depressive Disorder” (although there are no more recent records from 2015 or 2016). This information suggests there were no additional diagnoses overlooked during the MEB process. 5. The applicant underwent a TDRL examination as well as a TDRL PEB that considered his suicidal ideation. The TDRL PEB recommended his permanent retirement at a rate of 70 percent. That was the correct avenue for addressing rating concerns. 6. The Army conducted his disability evaluation in accordance with law and regulations and there does not appear to be an error or an injustice in his case. He has not submitted any evidence or argument that would show an error or injustice occurred in his disability processing. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20140020516 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20140020516 6 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2