Adjustment Disorder news
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Hey, folks. I'm new to the forum and I"m glad I stumbled across it when I did. I was looking up adjustment disorder and there you were. My MEB has been completed and just as I got it from my PEBLO I was told that it was on hold because of adjustment disorder with anxiety. Having read several posts I now get the gist of what it is and what is going on. As I understand it, we are waiting to find out if the Mil is going to allow it as a compensable disability, right? I only have one referred item and about 15 claims. My PEBLO said that this could work out to my benefit. Have we any idea of the timeframe involved? I have already extended once for my MEB. Other than that my timeline has been outstanding. I have heard horror stories from people on line and also from people iin my unit about waiting years for anything to happen. I am so glad that I found out about this forum! Please update the newbie, y'all. All the information I can get will obviously be greatly appreciated. I also have a question about the language used in the evaluations. Most of my conditions are written out completely and have diagnosis and affects on my life noted. However, one of my conditions, degenerative neuropathy causing chronic feet pain, appears like someone just quit writing mid paragraph. There is no note of diagosis or life affects. My PEBLO says that it doesn't matter and that the doc's will read the file and go from there. I have to disagree in that when they see this tiny writeup regarding my condition they are not going to give it the same weight that they would another condition with greater explanation. I was going to ask legal about this before I knew of this forum. Should I still consult them? Is there an SOP regarding these writeups? Please advise. Thanks again for being here. Back in a while. Boz48
Well, another day has come and gone with no new information on this issue. We've been told to expect an ALARACT to address not only what the criteria for meet/fail for Chronic Adjustment Disorder, but potentially even criteria for determining whether it is Acute or Chronic to begin with. More will follow as we get updates. At this point, anything someone may be telling you is likely pure speculation. I've been straight up with my soldiers that we simply do not know how this will work itself out. The silver lining is that this could potentially open up a lot of cases for retirement versus separation with severance pay. I think that makes the wait worthwhile, but it's still a pain in the ass.
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Thanks for the update...I am a bit concerned if the Army thinks they can place additional criteria beyond what is in the DSM-IV and VA regulations. Statutes make it clear that the military may not deviate from the VASRD. However, I will reserve judgment until we see what shakes out- could be that the Army just states that the existing regulations will be applied.
Keeping fingers crossed with Jason on this.
Could this "new and improved" Adjustment Disorder guidance have any effect on those who have already been discharged with AD and were NOT given a DoD rating for it in the past since many were found to be "fit" under this?
Would they have recourse to change their PDRL rating to include their AD and thereby increase their overall PDRL rating? Kinda like what happened to some in the past with PTSD - only they may not have to sue the government now to get their AD changed to a rated condition?
V/r,
nwlivewire
I actually posed the is question to my supervisor and the short answer was "No, at least not at this time." That being said, I wouldn't be the least bit surprised if we didn't end up doing another DoD wide review like we did for PTSD. Jason, I'm with you. It seems to me the DSM-IV is the definitive word on this, at least until the new DSMV comes out soon. I suspect they will continue to use the VA's VASRD. But what do I know, I sure wasn't expecting this big a change without any consideration at all to the consequences.
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Looking back in time, I think this will take a lawsuit to get relief for those whose cases were decided prior to the publication of the DoDI (at least to get widespread relief).
The problem, though, is not the change in policy; it is that the law has always required rating per the VASRD- and chronic adjustment disorder is in the VASRD. So, the change is not the cause of the problem, its the years that DoD has been denying compensation due to adjustment disorder (and, anecdotally, I think this was an "out" for denying compensation for what was actually PTSD- I saw a huge change in incidence of adjustment DO after the services grudgingly agreed that they had to apply 4.129 and give 50% temp rating for PTSD. And, saw many cases where original dx of PTSD was changed to Adjustment DO). Not to go off on a tangent- my point is that I am glad that after years of raising this issue, they are acknowledging that they have to do the right thing- apply the law as its written.
The problem, though, is not the change in policy; it is that the law has always required rating per the VASRD- and chronic adjustment disorder is in the VASRD. So, the change is not the cause of the problem, its the years that DoD has been denying compensation due to adjustment disorder (and, anecdotally, I think this was an "out" for denying compensation for what was actually PTSD- I saw a huge change in incidence of adjustment DO after the services grudgingly agreed that they had to apply 4.129 and give 50% temp rating for PTSD. And, saw many cases where original dx of PTSD was changed to Adjustment DO). Not to go off on a tangent- my point is that I am glad that after years of raising this issue, they are acknowledging that they have to do the right thing- apply the law as its written.
I agree that this should have been done a long time ago, and I agree that the policy change was necessary, but they are taking an awful lot of time to get this going if they are looking at how this will be adjudicated for meet/fail, chronic/acute. Those things are already policy. Why even consider changes? The DSM tells you what Chronic is, it is simple enough to see whether or not it fails retention standards, so what is the hold up? I am thinking they may potentially be considering even acute cases, or maybe that is what they are trying to work out?
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I have my hunches, and they mostly have to deal with some dysfunctional reviews and staffing process. But, it is just a hunch.
But, you raise up an interesting point (one that I have raised in several cases). If a member has an adjustment disorder that is acute when identified for MEB, almost by definition it will be chronic (unless it is resolved completely) by the time the PEB adjudicates the case, appeals are submitted, and orders can be cut, it will be more than 6 months and will, at that time be a chronic condition. So, whenever I see a PEB finding that mentions an acute adjustment disorder, my BS flag starts twitching.
But, you raise up an interesting point (one that I have raised in several cases). If a member has an adjustment disorder that is acute when identified for MEB, almost by definition it will be chronic (unless it is resolved completely) by the time the PEB adjudicates the case, appeals are submitted, and orders can be cut, it will be more than 6 months and will, at that time be a chronic condition. So, whenever I see a PEB finding that mentions an acute adjustment disorder, my BS flag starts twitching.
Exactly what I have brought up in discussions with other PEBLO's, and contacts at the PEB, Jason! I think we're all wondering if this is why this is taking so long. I think the outcome will certainly be TDRL for anyone with an adjustment disorder, much like the majority of PTSD cases. However, many of the adjustment disorder cases I've worked had 30% for it from the VA. Good enough for retirement anyway. It will be interesting to see how the 6 month post separation VA review will go.
ALCON:
Any insights as to when the new DSM-V will be available for implementation by DoD and DoVA after its potential scheduled release in May 2013?
Best Wishes!
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Not sure I understand the question. DoD applies it because the VA does. So it is VA implementation that counts. The VA reg states:
"§ 4.130 Schedule of ratings—mental disorders.
The nomenclature employed in this portion of the rating schedule is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-IV)."
So, it will be available for implementation as soon as the VA Secretary updates the regulation (I don't think this will require notice and comment rulemaking- so it should follow almost immediately).
Did I misunderstand the question? (BTW, they have been promising DSM-V for years...don't know what takes so long. You will see some cases quote DSM-IV TR- transition rewrite- technically, I think that is wrong).
There was not any misunderstanding of the question as based upon the above highlighted response.
To that extent, I appreciate the feedback and thanks for your prompt response.Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."
Best Wishes!
Okay, here's the skinny from the big teleconference today. I've already passed this on to the soldiers in my AOR. All cases at the PEB with Adjustment Disorder will be returned to the MTFs for review by Behavioral Health. They will have to diagnose Chronic vs Acute. They will use the following guidelines to make that determination, Is it a condition lasting longer than 6 months? If yes, then it is Chronic. The next question is, if chronic, does it fail retention standards? The answer there is if the soldier has had to have inpatient care, i.e. hospitalization, and/or do they have to be in a safe protected environment? Basically, some of the same criteria for PTSD for example no weapons, no duty simulating war, etc. If the answer is yes, then the condition will fail. So what happens after the Behavioral Health people do that part? The addendum will be the basis for a new DA3947 for that condition only . The DA3947 will be routed through Physician Review and then will be presented to the soldier. At that point, the soldier will be able to make an election to concur or nonconcur with the findings and recommendations. Remember, this will only have the adjustment disorder on it. The soldier has the right to an IMR and one appeal. If the condition doesn't fail retention standards, the soldier's case will continue from the point it was at when stopped, for example at DRAS, transition, etc. If the condition fails retention standards, then the condition will be factored in for separation purposes. We are not uploading any new cases to the PEB with adjustment disorders in order to allow those cases that are in transition, especially those that already have separation orders, to be run through first.
Another thing is if you had a comorbid behavioral health issue listed by the VA, for example Anxiety Disorder NOS, and Adjustment Disorder, the other condition will be the one used as you really shouldn't have two separate BH conditions of this nature. They would use the Anxiety Disorder instead of the adjustment disorder.
Lastly, this is coming out on a memorandum from the OTSG. It is still pending the Secretary of Defense's signature so nothing is in play until he signs. This memorandum will be in effect until the 40-501 is updated to include the changes. That's about all I can recall off the top of my head, if there are specific questions, let me know and I will try to remember if that was discussed. Remember, this is still very fluid since they have a knack of not war gaming these things out ahead of time. I hope this helps some of you.
Another thing is if you had a comorbid behavioral health issue listed by the VA, for example Anxiety Disorder NOS, and Adjustment Disorder, the other condition will be the one used as you really shouldn't have two separate BH conditions of this nature. They would use the Anxiety Disorder instead of the adjustment disorder.
Lastly, this is coming out on a memorandum from the OTSG. It is still pending the Secretary of Defense's signature so nothing is in play until he signs. This memorandum will be in effect until the 40-501 is updated to include the changes. That's about all I can recall off the top of my head, if there are specific questions, let me know and I will try to remember if that was discussed. Remember, this is still very fluid since they have a knack of not war gaming these things out ahead of time. I hope this helps some of you.
I'm a little concerned. Are you saying that if the condition meets retention standards, it will not be added to the DA 3947? Are they trying to state if it meets retention standards it won't be found unfitting?
There were many who were put out for adjustment disorder who were not hospitalized or required a safe protective environment. How can they now say these are requirements for the condition not to meet retention standards when it was not the standard in the past?
Mike
There were many who were put out for adjustment disorder who were not hospitalized or required a safe protective environment. How can they now say these are requirements for the condition not to meet retention standards when it was not the standard in the past?
Mike
There will be no retroactive cases. If someone was separated before 10 April 2013, they are out of luck. If a soldier separated on 9 April 13, they are done. It looks like the DoD is working on what to do with the soldiers who slipped through the cracks and were allowed to separate with an adjustment disorder, that should have had their orders rescinded. Essentially if the condition doesn't fail retention standards, then it will not play a part in separation. That is the case for any condition that meets retention standards. The VA will rate it, but it won't help in boosting the combined rating for separation purposes. I can tell you that at our MTF all conditions listed on the VA C&P are listed on the NARSUM and then the DA3947. So we have always listed even adjustment disorders under conditions that meet retention standards. So to answer the questions directly, if a condition, and that is any condition, meets retention standards, it is listed on the DA3947 as a condition claimed meeting retention standards. Part 2 of your question is answered in your question. If a condition meets retention standards, it is then by definition fitting. Let me know if this isn't answering your questions.
The position that a condition that meets retention standards is by definition fitting violates DoDI 1332.38 which states:
DoDI 1332.38 requires all conditions to be covered in the MEB with full clinical data. This is a problem I see all too often - The MEB does not cover all medical conditions with full clinical data. A related problem is when the NMA does not specify what conditions impact duty performance. Without such clarity of the medical data and in the NMA, the PEB cannot properly determine which conditions are independently unfitting or that contribute to unfitness and this can shortchange the wounded warrior out of disability benefits.
Again, I have seen way too many soldiers in the past who were administratively discharged for adjustment disorder without being hospitalized or requiring a safe protective environment. These individuals were deemed unfit with a non compensable condition and administratively separated. Now suddenly in order to be deemed unfit for adjustment disorder, one must not meet a retention standard based on hospitalization or the requirement for a safe protective environment. Does that mean a soldier with acute adjustment disorder who has not required hospitalization or a safe protective environment should not be administratively separated? Is there cause for appeal (class action lawsuit) for those who were administratively discharged over the years for adjustment disorder but who did not require hospitalization or a safe protective environment? By that standard they were not unfit and should have been allowed to stay in service.
It appears the Army policy will not change much in terms of the compensability of adjustment disorder as it will just be found not to be an unfitting condition due to this hospitalization/safe environment retention standard.
I might add that just because a condition does not meet retention standards does not mean a condition is unfitting. Thus, why would it be true that if a condition meets retention standards it cannot contribute to overall unfitness in light of the requirement in paragraph E3.P3.4.4. of DoDI 1332.38?
To be fair, the PEB needs to determine if the adjustment order was independently unfitting or contributed to unfitness regardless if it met any newly devised retention standard. Such a fitness assessment needs to be made based on the full clinical data of the adjustment disorder as well as a NMA addressing the adjustment disorder's impact on duty performance.
E3.P3.4.4. Overall Effect. A member may be determined unfit as a result of the overall effect of two or more impairments even though each of them, standing alone, would not cause the member to be referred into the DES or be found unfit because of physical disability.
Conditions that meet retention standards can contribute to overall unfitness and, by law, such conditions must be rated per the VASRD as part of the DoD rating. See the 14 October 2009 DoD DTM.DoDI 1332.38 requires all conditions to be covered in the MEB with full clinical data. This is a problem I see all too often - The MEB does not cover all medical conditions with full clinical data. A related problem is when the NMA does not specify what conditions impact duty performance. Without such clarity of the medical data and in the NMA, the PEB cannot properly determine which conditions are independently unfitting or that contribute to unfitness and this can shortchange the wounded warrior out of disability benefits.
Again, I have seen way too many soldiers in the past who were administratively discharged for adjustment disorder without being hospitalized or requiring a safe protective environment. These individuals were deemed unfit with a non compensable condition and administratively separated. Now suddenly in order to be deemed unfit for adjustment disorder, one must not meet a retention standard based on hospitalization or the requirement for a safe protective environment. Does that mean a soldier with acute adjustment disorder who has not required hospitalization or a safe protective environment should not be administratively separated? Is there cause for appeal (class action lawsuit) for those who were administratively discharged over the years for adjustment disorder but who did not require hospitalization or a safe protective environment? By that standard they were not unfit and should have been allowed to stay in service.
It appears the Army policy will not change much in terms of the compensability of adjustment disorder as it will just be found not to be an unfitting condition due to this hospitalization/safe environment retention standard.
I might add that just because a condition does not meet retention standards does not mean a condition is unfitting. Thus, why would it be true that if a condition meets retention standards it cannot contribute to overall unfitness in light of the requirement in paragraph E3.P3.4.4. of DoDI 1332.38?
To be fair, the PEB needs to determine if the adjustment order was independently unfitting or contributed to unfitness regardless if it met any newly devised retention standard. Such a fitness assessment needs to be made based on the full clinical data of the adjustment disorder as well as a NMA addressing the adjustment disorder's impact on duty performance.
Mike
Not saying I disagree with you. I tell my soldiers this myself when I do my initial counseling with them. I'm just putting out what was said. The memorandum from OTSG may offer more clarification. We will see once it comes out this coming week. That being said, I have seen almost every DA199 say, and I'm paraphrasing here, "These other conditions, whether separate or combined, do not result in an unfit finding." Or words to that effect.
I sometimes think the PEB is living in delusion world. I've seen a soldier have one failing condition and 20 fitting conditions. I have a hell of a time agreeing that having 20 other things all going on at the same time leaves a guy able to do his MOS or basic soldier skills.
My real issue with adjustment disorder as a diagnosis is that very often I see the MTF behavioral health try to say it is an adjustment disorder when a soldier has seen his friends die, and it is the source of his problem. Sorry, but a soldier shouldn't become adjusted to that. If there are tie ins to that type of event, it is better classified as PTSD. Just my opinion.
FYI, it appears a soldier that has just an adjustment disorder, and it is acute, will not be sent to the MEB. He would still chapter out.
I sometimes think the PEB is living in delusion world. I've seen a soldier have one failing condition and 20 fitting conditions. I have a hell of a time agreeing that having 20 other things all going on at the same time leaves a guy able to do his MOS or basic soldier skills.
My real issue with adjustment disorder as a diagnosis is that very often I see the MTF behavioral health try to say it is an adjustment disorder when a soldier has seen his friends die, and it is the source of his problem. Sorry, but a soldier shouldn't become adjusted to that. If there are tie ins to that type of event, it is better classified as PTSD. Just my opinion.
FYI, it appears a soldier that has just an adjustment disorder, and it is acute, will not be sent to the MEB. He would still chapter out.