IN THE CASE OF: BOARD DATE: 19 July 2016 DOCKET NUMBER: AR20160010343 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: 19 July 2016 DOCKET NUMBER: AR20160010343 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. IN THE CASE OF: BOARD DATE: 19 July 2016 DOCKET NUMBER: AR20160010343 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 MH 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. The applicant?s physical evaluation board (PEB) adjudicated major depressive disorder (MDD), recurrent with paranoid features and anxiety disorder, not otherwise specified (NOS) as unfitting and awarded a 70 percent disability rating. Contrary to the PEB's findings, the DD Form 2808 (Report of Medical Examination), dated 8 October 2010, stated post-traumatic stress disorder (PTSD) in block number 77 (Summary of Defects and Diagnoses.) 4. In the processing of this case, an advisory opinion was obtained from the PDBR SRP. The SRP noted the applicant gave inconsistent accounts of symptoms, initially stating there were none, then stating they were present after his return from deployment, and then endorsing depression onset in April 2008. The applicant did not report MH symptoms or seek MH support during deployment. Although he reported he used cannabis to treat nightmares, he had a history of cannabis abuse since high school. He also had a history of psilocybin use. Both agents were associated with serious, chronic mental issues, often as a co-morbid condition, exacerbation of underlying mood/psychotic illness or direct damage to brain cells that may result in highly aggressive behaviors. The applicant endorsed depression and suicidal ideation prior to entering the military in association with the use of cannabis and psilocybin, the same substances associated with his first hospitalization post-deployment in 2008. During the second hospitalization, he reported near daily use of 1-1.5 grams of marijuana. His first visits to MH post-deployment appeared to be in association with substance abuse and were shortly followed by his first two hospitalizations. 5. The psychiatric narrative summary (NARSUM), the exam most proximate to separation, noted his most prominent symptoms were that of aggression and weight loss captured in diagnoses of MDD with paranoid features; anxiety disorder, NOS; and intermittent explosive disorder. Many of his behaviors (failure to pay bills, entitlement to pay, deliberate plans to never work) appeared related to his personality disorder. The applicant’s statement in 2013 was consistent with that diagnosis. There was little or no evidence of combat stressors associated with symptoms of PTSD. The psychiatric NARSUM examiner noted he did not meet criteria for PTSD at separation but did have evidence of an anxiety disorder. 6. The SRP agreed that at the time of separation a diagnosis of PTSD was not supported by the available record. Although the applicant was deployed to a combat zone and likely had combat exposures, no commander’s statement or collateral information confirms the report of combat stressors or describes any negative effects to his duty performance. There was a history of depression and suicidal ideation both pre- and post-deployment in association with substance abuse that was likely due to an underlying mental illness; however, there was no record in evidence of a formal diagnosis and treatment of MDD until post-deployment. Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, was subsumed under a single rating using the same criteria in accordance with (IAW) Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) Section 4.130. The SRP agreed application of VASRD 4.129 was appropriate and recommended constructive entrance onto the Temporary Disability Retired List (TDRL) at a 70 percent rating under VASRD code 9434 (MDD) for a period of 6 months. 7. The available record contains no data regarding the applicant’s functioning close to the period 6 months following separation to comply with the constructive TDRL assessment requirement. Since the VA examiner assigned a “guarded” prognosis to the combination of PTSD and depressive disorder diagnoses; the NARSUM examiner had described the prognosis as “terrible;” and in the absence of data to suggest total occupational and social impairment, the SRP agreed that there was insufficient evidence to suggest a change in the 70 percent rating at the end of the constructive TDRL period. 8. The SRP considered the appropriateness of changes in MH diagnoses, whether the provisions of the VASRD Section 4.129 were applicable, and a disability rating recommendation in accordance with VASRD Section 4.130. The VA adjudicated PTSD prior to the medical evaluation board (MEB); however, the MEB and the PEB categorized the applicant’s condition not as PTSD, but as MDD, recurrent with paranoid features and anxiety disorder, NOS. 9. The applicant was provided a copy of this advisory opinion for review and comment. He did not respond. DISCUSSION AND CONCLUSIONS: 1. The SRP concluded that the applicant’s case did meet the inclusion criteria for the Terms of Reference of the MH Special Review Panel. After a comprehensive review of the applicant’s case, the SRP recommended by unanimous vote that the applicant’s retirement be modified to reflect that he was placed on the TDRL at 70 percent for a period of 6 months (IAW VASRD 4.129) and permanently retired at 70 percent. 2. The available evidence supports the SRP’s assessment. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20160010343 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20160010343 3 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2