RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201844 SEPARATION DATE: 20040226 BOARD DATE: 20130228 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SPC/E-4 (62E10/Heavy Equipment Operator), medically separated for obsessive compulsive disorder (OCD). Despite treatment the CI could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the OCD condition as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 10% disability rating. CI CONTENTION: “Due to the difficulty maintaining a job for a long period of time. Need more deserving rating” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20031107 VA (6 Mos. Post-Separation) – All Effective Date 20040227 Condition Code Rating Condition Code Rating Exam Obsessive Compulsive Disorder 9404 10% Obsessive Compulsive Disorder 9404 10% 20040819 .No Additional MEB/PEB Entries. Not Service-Connected x 2 20040819 Combined: 10% Combined: 10% ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the service member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation. Obsessive Compulsive Disorder Condition. The CI was activated with his unit 11 February 2003 and deployed to Iraq in April 2003. After arrival in Iraq, the CI presented with recurrent, intrusive thoughts without related compulsions that were disconcerting and prevented him from being able to concentrate and focus on his duties and tasks. No traumatic events were reported or recorded in any available records. He was initially evaluated while in theater but then was evacuated to Germany in July for an inpatient stay where he was started on medication. He was returned to the United States at the end of July 2003. The MEB narrative summary (NARSUM), dictated 29 July 2003, a day after arrival in the U.S., records the CI reported total resolution of his recurrent obsessive thoughts and resolution of all of his depressive symptoms. He attributed the improvement to treatment with the medication and reported that he was tolerating the medication well. The MEB physical examination noted the CI had normal appearance, speech, mood, and affect. He displayed mild psychomotor agitation (tapping his foot) throughout the interview. The CI reported his mood as “good” and he denied any thoughts of harming self or others. There were no signs or symptoms of psychosis noted. The CI was married and living with family at that time. A family practice clinic follow up appointment on 21 August 2003 recorded: “SM stated that he had mental problem prior to his deployment but not as severe as it is now. However the current medication is working well.” No further service treatment record (STR) entries are in evidence. The PEB noted “symptoms have largely resolved on…” medication. At the VA Compensation and Pension (C&P) examination, performed 19 August 2004, 6 months after separation, the CI reported he was never in any combat and did not report any specific traumatic events that occurred while he was in Iraq. The examiner noted that posttraumatic stress disorder (PTSD) screening was negative in June 2004. The CI reported that he was still taking his medication and that he had no problems, at that time. The CI reported that his medication made him feel as if he had more control of himself, compared to a year prior. He said he occasionally felt “down or a little blue” but he felt it was “well managed” with his medication. He was not engaged in therapy. The CI reported that his sleep and appetite were both good. He reported only a rare occasion of alcohol use but not substance use or abuse. The CI had been working full time at a grocery store (a job he held prior to activation) for 3 months and reported no lost time from work due to his condition. He had divorced his wife and his son was a year old who was in the custody of his wife. He said his marriage broke up because his wife was not willing to move and because of financial difficulties. The CI was living on his family’s property and was attending church on a regular basis. The CI reported being involved in a relationship and enjoying hobbies when he was not working. He reported that he had no legal issues, other than driving on a suspended license, to report. The examiner noted had no noticeable deficits and his memory was intact. The examiner‘s opinion was that the CI was “relatively symptom free” but might benefit from supportive psychotherapy. The Board directs attention to its rating recommendation based on the above evidence. It was first adjudged that this case did not meet the requirements for application of a retroactive temporary duty retired list (TDRL) rating IAW VASRD §4.129. The psychiatric condition was adjudged to not be a result of a “highly stressful event” (as per §4.129). Both the PEB and VA applied the same code, 9404 (OCD) and the same rating, 10% IAW VASRD General Rating Formula for Mental Disorders. There was no evidence of occupational and social impairment in either the MEB NARSUM or C&P proximate to the time of separation however it was clear that the CI’s had a mental health diagnosis and that the condition was controlled by his continuous use of medication. This meets the criteria for a 10% rating in the general rating formula. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the OCD condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the OCD condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Obsessive Compulsive Disorder 9404 10% RATING 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20121015, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxx, AR20130006189 (PD201201844) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)