BOARD DATE: 3 March 2016 DOCKET NUMBER: AR20160002812 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 mental health diagnosis was changed during that process. 3. The applicant submitted an application through the DOD Physical Disability Board of Review (PDBR) Mental Health Special Review Panel (SRP). CONSIDERATION OF EVIDENCE: 1. The PDBR SRP conducted a comprehensive review of the applicant’s submissions and records for evidence of inappropriate changes in the diagnosis of a mental health condition during processing through the military disability system. 2. The Department of Defense memorandum, dated 27 February 2013, directed the Service Secretaries to conduct a review of mental health 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 applicant’s case, the SRP determined by unanimous vote that there be no change of the applicant’s disability and medical retirement determination. 2. The SRP reviewed the records for evidence of inappropriate changes in diagnosis ofthe MH condition during processing through the military Disability Evaluation System (DES). The evidence of the available records show the diagnoses of cognitive disorder not otherwise specified (NOS) secondary to Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD) were rendered during processing. Therefore, the SRP determined that the MH diagnoses were not changed to the applicant’s possible disadvantage during the disability evaluation. The applicant did not appear to meet the inclusion criteria in the Terms of Reference (TOR) of the MH Diagnosis Review Project. 3. The SRP agreed that the Physical Evaluation Board (PEB) adjudication of unfitting cognitive disorder secondary to TBI associated with PTSD was well supported by the evidence. The SRP agreed the evidence supported the PEB’s use of analogous codes 8045-9304 (Residuals of TBI and dementia due to head trauma). Regardless ofdiagnosis, the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.130 rated conditions based on symptoms, and therefore, all symptoms related to MH were considered in the rating scheme. 4. The SRP next considered if the application of the provisions of VASRD Section 4.129 were applicable in the applicant’s case. The PEB indicated that 10 A/C was awarded “for the right orbital fracture and cognitive disorder”; however, PTSD was not included. The SRP noted the US Army Physical Disability Agency’s (USAPDA) review worksheet indicated that VASRD Section 4.129 was applicable. However, in a memorandum referencing the National Defense Authorization Act (NDAA) 2008 with the subject matter of “Administrative Change to DA Form 199, the USAPDA noted that there “was no change to the applicant’s overall rating or disposition.” After considerable discussion, the SRP agreed that cognitive disorder was the primary diagnosis by the narrative summary (NARSUM) psychiatrist, neuropsychologist and the Department of Veterans Affairs (VA) examiner at the time of Temporary Disability Retired List (TDRL)placement; thus, the provisions for VASRD Section 4.129 (a highly stressful event to bring about release from military service) were not met. 5. The SRP later considered if there was evidence for a VASRD Section 4.130 rating higher than 30 percent at the time of TDRL placement. The NARSUM examiner recorded evidence to support the 30 percent criteria and noted that the applicant met the 30 percent criteria for occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks due topsychiatric symptoms. The SRP considered the rating scheme under the cognitive impairment related to residual of TBI and found insufficient evidence to support the use of this rating scheme. The SRP reviewed the commander’s statement and noted there was no reference made to difficulty with cognition or PTSD symptoms. The commander’s statement stated the applicant was “physically incapable of reasonably performing his duties due to his extensive facial fractures.” The SRP noted the higher rating of 50 percent under VASRD Section 4.130 required evidence of “occupational and social impairment with reduced reliability and productivity; was not supported by the evidence. There was no evidence of suicidal ideations or behaviors, no visits to the emergency room (ER) for MH treatment, no psychiatric hospitalizations, no reported panic attacks, and no evidence of impairment in thinking, or judgment. 6. After due deliberation, considering all of the evidence and mindful of VASRD Section 4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the cognitive disorder secondary to TBI associated with PTSD, rated 30 percent at TDRL placement. 7. The SRP agreed, at the time of permanent retirement, that the evidence adequately showed the applicant continued to report PTSD symptoms and met criteria for the diagnosis. The cognitive disorder NOS condition was not assessed. During the December 2013 neuropsychological evaluation, the examiner stated, “The persistent reported cognitive complaints were more consistent with a psychiatric etiology and would be subsumed under his diagnosis of PTSD.” The evidence showed the applicant’s MH symptoms had improved. He had worked full-time and was closer to achieving his goal of completing his college degree, but he had difficulty keeping up with his course work. He was still married with continued marital difficulties. His socialization was limited due to self-reported PTSD symptoms. The applicant was not hospitalized psychiatrically within 12 months of retirement, but had participated in a residential rehabilitation program for poly substance abuse and PTSD. He took only one psychotropic medication, reported no panic attacks, had no visits to the ER for MH concerns, and although he reported minimal symptoms, the psychologist opined that he had likely minimized his condition since he wanted to be found fit for duty. There were no reports of domestic or community violence, legal history, nor suicidal or homicidal thoughts, plan, intent, or attempt at any time. His Mental Status Exam (MSE) recorded no impairment in judgment, noted no evidence of psychosis, and no issues in orientation or hygiene. 8. After due deliberation, considering all of the evidence and mindful of VASRD Section 4.3 (reasonable doubt), the SRP concluded that there was insufficient cause to recommend a change in the PEB adjudication for the PTSD condition, rated 50 percent at TDRL removal/permanent retirement. 9. The available evidence shows the SRP’s 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 3 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1 ABCMR Record of Proceedings (cont) AR20160002812 4 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1