IN THE CASE OF: BOARD DATE: 7 July 2016 DOCKET NUMBER: AR20150002689 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: 7 July 2016 DOCKET NUMBER: AR20150002689 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. IN THE CASE OF: BOARD DATE: 7 July 2016 DOCKET NUMBER: AR20150002689 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 correction of his Narrative Summary, dated 31 January 2011, in connection with his medical evaluation board (MEB) to show post-traumatic stress disorder (PTSD) instead of attention deficit hyperactivity disorder (ADHD). 2. The applicant states: a.  Dr. A____ L. P____ stated he had PTSD. The symptoms listed in the doctor's diagnosis all indicate PTSD. Impairment for further duty was marked; impairment for social/industrial adaptability is definite. b.  The rating he received does not reflect the mental health condition he suffers from and he believes this is in error and unjust. 3. The applicant provides: * DD Form 214 (Certificate of Release or Discharge from Active Duty) * Narrative Summary from Winn Army Community Hospital, dated 31 January 2011 CONSIDERATION OF EVIDENCE: 1. Having prior honorable service in the Regular Army and U.S. Army Reserve, the applicant enlisted in the Army National Guard on 2 October 1991. 2. A Narrative Summary, dated 31 January 2011, shows he was evaluated by a psychiatrist for MEB processing and: * the applicant reported receiving behavioral health treatment at the Department of Veterans Affairs (VA) clinic in Savannah, GA, from 2006 to present * on 5 March 2010, he underwent psychological testing and no psychiatric diagnosis was rendered * on 19 March 2010, his Warrior Transition Unit diagnostic impression was anxiety disorder (not otherwise specified (NOS)) * on 18 May 2010, he was administered the Connors Continuous Performance Test II and his diagnostic impression was mild attention deficit disorder * on 6 October 2010, a VA psychologist rendered a diagnostic impression of mild, chronic PTSD * on 28 January 2011, his routine Warrior Transition Unit visit diagnostic impression was anxiety disorder (NOS) * on 31 January 2011, he was diagnosed with Axis I – PTSD and Axis I – ADHD and his conditions met medical retention standards 3. His DA Form 3947 (Medical Evaluation Board Proceedings), dated 15 February 2011, shows he was diagnosed with the following conditions and referred to a physical evaluation board (PEB): * chronic cervical spondylosis, degenerative disc disease, and central stenosis – VA diagnosis – cervical spondylosis * chronic left shoulder pain with impingement, status post-clavicular facet fracture malunion – VA diagnosis – left shoulder impingement syndrome * chronic lumbar degenerative disc and joint disease – VA diagnosis – lumbar thoracic strain * bilateral carpal tunnel syndrome – VA diagnosis – bilateral carpal tunnel syndrome * PTSD – meets retention standards – VA diagnosis – mild, chronic PTSD * ADHD – predominantly inattentive type – meets retention standards – VA diagnosis – no diagnosis * VA diagnosis – post-concussive syndrome – meets retention standards * VA diagnosis – chronic headaches – meets retention standards * VA diagnosis – hypertension – meets retention standards * VA diagnosis – erectile dysfunction – meets retention standards * VA diagnosis – mild scoliosis – meets retention standards * VA diagnosis – healed left clavicle fracture with malunion – meets retention standards * VA diagnosis – sleep apnea with continuous positive airway pressure machine – meets retention standards * VA diagnosis – bilateral intermittent tinnitus – meets retention standards 4. His DA Form 199 (PEB Proceedings), dated 2 December 2011, shows his informal findings were reconsidered based on his appeal. This form shows his DA Form 199, dated 4 August 2011, was superseded. His DA Form 199, dated 4 August 2011, is not available for review. 5. On 2 December 2011, a PEB adjudicated as part of the Integrated Disability Evaluation System (IDES) found him physically unfit for continued service and recommended his permanent disability retirement with a disability rating of 40 percent. a.  His unfitting conditions were rated as follows: * degenerative arthritis of the cervical spine – 20 percent * left non-dominant shoulder impingement syndrome – 10 percent * degenerative arthritis of the thoracolumbar spine – 10 percent * right carpal tunnel syndrome – 0 percent * left carpal tunnel syndrome – 0 percent b.  His conditions listed below were found by the PEB to not be unfitting: * PTSD * post-concussive syndrome * chronic headache * hypertension * erectile dysfunction * mild scoliosis * healed left clavicle fracture * sleep apnea with continuous positive airway pressure machine * bilateral intermittent tinnitus c.  His condition of ADHD, predominantly inattentive type, was listed as a condition not constituting a physical disability. 6. On 15 December 2011, the applicant concurred with the recommendations and findings of the PEB, waived his right to a formal hearing, and declined reconsideration of his VA ratings. 7. On 27 December 2011, the recommendations and findings of the PEB were approved for the Secretary of the Army. 8. On 27 April 2012, the applicant was retired due to permanent disability with a disability rating of 40 percent. 9. On 8 June 2016, the Chief, Behavioral Health Division, Office of the Surgeon General, provided an advisory opinion in which he noted: a.  Although PTSD was included on the list of diagnoses submitted by the PEB, the Board concluded on 15 February 2011 that the disorder met retention standards. This was consistent with the profile noted in the Narrative Summary that indicated he was fit for duty at the time. b.  An inconsistency in the applicant's Narrative Summary that the description of his PTSD symptoms impairing his functioning "a little bit" in contrast to the observation that impairment for further military duty was "marked" and impairment for social/industrial adaptability "definite." c.  Despite the inconsistencies in the Narrative Summary and questions regarding the severity of the applicant's symptoms, the evidence clearly indicates he was diagnosed with PTSD while still in service, most likely at a level of severity that did not meet retention standards at the time of his discharge. d.  His 6 October 2010 evaluation by a VA psychologist concludes a well-substantiated diagnosis of PTSD, mild, chronic, and the Disability Evaluation System proposed rating conducted on 15 July 2011 that granted him a 30 percent rating for service-connected PTSD. 10. On 10 June 2016, a copy of the advisory opinion was sent to the applicant for review and an opportunity to provide a response. He did not respond by the suspense date. REFERENCES: 1. Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) establishes the Army Physical Disability Evaluation System (PDES) and sets forth policies, responsibilities, and procedures that apply in determining whether a member is unfit because of physical disability to perform the duties of his or her office, grade, rank, or rating. a.  The mere presence of impairment does not, of itself, justify a finding of unfitness because of physical disability. b.  The medical treatment facility commander with primary care responsibility evaluates those referred to him or her and, if it appears as though the member is not medically qualified to perform duty or fails to meet retention criteria, refers the member to an MEB. Those members who do not meet medical retention standards are referred to a PEB for a determination of whether they are able to perform the duties of their grade and military specialty with the medically-disqualifying condition. 2. The Department of Defense/VA Disability Evaluation System (DES) Pilot Program Operations Manual establishes the scope, policy, responsibilities, and execution instructions for the Department of Defense/VA DES Pilot Program. a.  Paragraph 4.2 states that for the purpose of the DES Pilot Program, the Military Secretary concerned will use the VA disability ratings awarded to each of the military unfitting conditions to determine the combined Department of Defense disability rating for all military unfitting conditions. b.  Paragraph 5.4.6 states the Secretaries of the Military Departments shall accept the disability rating(s) awarded for each of the military unfitting condition(s) rendered by the VA DES rating activity site in determining separation and other administrative matters including final disposition from the Temporary Disability Retired List. 3. The VA Schedule for Rating Disabilities (VASRD) is the standard under which percentage rating decisions are to be made for disabled military personnel. The VASRD is primarily used as a guide for evaluating disabilities resulting from all types of diseases and injuries encountered as a result of or incident to military service. Unlike the VA, the Army must first determine whether a Soldier is fit to reasonably perform the duties of his or her office, grade, rank, or rating. Once a Soldier is determined to be physically unfit for further military service, percentage ratings are applied to the unfitting conditions from the VASRD. These percentages are applied based on the severity of the condition. 4. Title 38, U.S. Code, sections 1110 and 1131, permit the VA to award compensation for disabilities which were incurred in or aggravated by active military service. However, an award of a higher VA rating does not establish error or injustice on the part of the Army. The Army rates only conditions determined to be physically unfitting at the time of discharge which disqualify the Soldier from further military service. The Army disability rating is to compensate the individual for the loss of a military career. The VA does not have authority or responsibility for determining physical fitness for military service. The VA awards disability ratings to veterans for service-connected conditions, including those conditions detected after discharge, to compensate the individual for loss of civilian employability. As a result, these two government agencies, operating under different policies, may arrive at a different disability rating based on the same impairment. Unlike the Army, the VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. DISCUSSION: 1. The applicant requests correction of his Narrative Summary to show a diagnosis of PTSD instead of ADHD. 2. His Narrative Summary shows he was diagnosed with both PTSD and ADHD and both conditions were not found unfitting. 3. The Chief, Behavioral Health Division, Office of the Surgeon General, noted inconsistencies in the applicant's Narrative Summary and stated the evidence clearly indicates he was diagnosed with PTSD while still in service, most likely at a level of severity that did not meet retention standards at the time of his discharge. 4. Nevertheless, he was processed through the IDES and his DA Form 199 shows he appealed the original findings. Upon review of his appeal, his conditions of PTSD and ADHD were again found not unfitting. He concurred with the findings and recommendation of the PEB, declined a formal hearing, and declined to submit a request for reconsideration of his VA ratings. 5. The Army must find that a Soldier is physically unfit to reasonably perform his or her duties and assign an appropriate disability rating before he or she can be medically retired or separated. A disability rating assigned by the Army is based on the level of disability at the time of the Soldier's separation and can only be accomplished through the PDES. 6. An award of a VA rating does not establish error in the rating assigned by the Army's disability evaluation system. Operating under different laws and its own policies, the VA does not have the authority or the responsibility for determining medical unfitness for military service. The VA awards ratings because of a medical condition related to service (service connected) and affects the individual's civilian employability. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150002689 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150002689 7 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2