RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD1301212
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140128
SEPARATION DATE:  20011123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-6 (3C371/Communication Computer Systems Plan & Imp) medically separated for major depression.  The CI has a long psychiatric history beginning in 1990 according to his treatment records.  In February 2000, he was diagnosed with anxiety disorder not otherwise specified and dysthymic disorder.  He was receiving treatment for anxiety symptoms and panic attacks.  His mental health (MH) condition could not be adequately rehabilitated to meet the requirements of his Air Force Specialty (AFS).  He was issued a temporary S-4 profile and referred for a Medical Evaluation Board (MEB).  Major depressive disorder (MDD) was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The PEB adjudicated major depression as unfitting and rated it 10%, with application the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI attached a twelve page statement to his application which was reviewed by the Board and considered in its recommendations.  In addition to the mental health condition, he contended for hypertension and hearing loss.

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting MH condition is addressed below.  The requested “uncontrolled hypertension” will also be addressed.  The requested hearing loss was not identified during the Disability Evaluation System (DES) process, and thus is not within the DoDI 6040.44 defined purview of the Board.  The Board acknowledges the CI’s request for a retroactive promotion to E6.  The Board does not have the jurisdiction to offer remedy in reference to decisions of this nature.  That authority resides with the Board for the Correction of Military Records (BCMR).  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 BCMR.

RATING COMPARISON:

Service IPEB – Dated 20011002	VA -  Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depression	9434	10%	Major Depression	9434	30%	STR	
Tobacco Abuse	CAT III	No VA Entry	
No Additional MEB/PEB Entries	Other x 2	STR	
Rating:  10%	Combined Rating:  40%	
Derived from VA Rating Decision (VARD) dated 20011218 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Major Depressive Disorder.  The CI first sought medical treatment for an MH condition on 17 May 1990, 6 months after his second enlistment following a break in service of less than a year.  He overdosed on pills in what was determined to be a suicidal gesture by the emergency room physician.  He was referred to MH and was determined to be angry and depressed from marital problems stemming from an affair by his spouse.  He began marital counseling and the case was closed on 11 June 1990.  He subsequently cleared for a special duty assignment.  He was again seen in 1994 for stress-related headaches and multiple times in 1995 for anxiety.  Biofeedback training was initiated.  The CI maintained an S1 profile during this period of time and subsequently as well until he was in the DES process.  In 2000, the CI again engaged the MH clinic and was found to have both anxiety and dysthymic disorders.  He was seen on a regular basis for counseling, but referred for an MEB on 3 November 2000 due to his past psychiatric history.  Again, the profile was S1.  On 9 November 2000, it was noted that there had been a prior hospitalization and a temporary S4 profile was issued.  At the following MH visits, the (permanent) S1 profile was maintained.  The Board reviewed the numerous performance reports in the record.  He was considered a stellar performer and promotion was recommended ahead of his peers.  His final report which covered the period from 12 June 2000 to 11 June 2001 noted “advancement in the Air Force is a must—promote soonest!” and “Easily ranks among the top of his peer group, and continues to raise the bar—promotion to TSgt is a must!”  The psychiatric narrative summary was dated 19 September 2001.  The CI reported for determination of the need for an MEB.  He reported MH care both on base and with a civilian provider.  He stated that he had gained 40 pounds over the past 2 years which he attributed to the use of Zoloft.  The review of systems was positive for depressed mood, poor sleep, decreased pleasure and interest, decreased energy and concentration, poor appetite (despite weight gain), no current suicidal ideation but noted an attempt at 16, irritability, intermittent hopelessness and helplessness and panic attacks controlled with Zoloft.  It was noted that he had been an in-patient in a civilian psychiatric hospital.  He endorsed frustration with the question of his status.  He endorsed significant family of origin trauma in that a brother died traumatically and a sister was raped and murdered.  He had been married three times and was currently in a poor relationship.  The mental status examination was significant for mild psychomotor agitation, a dysthymic mood and dysphoric, anxious affect.  He was diagnosed with MDD with marked military impairment, but mild civilian impairment noting substantial civilian employment potential.  He was not world-wide qualified for assignment.  The commander’s letter was dated 27 September 2001 and stated that the CI was an outstanding performer when present for duty.  He had frequent absences though due to medical appointments.  The CI retained access to classified information until the security termination agreement was accomplished on 18 October 2001.  He was awarded an AF Commendation medal for the time period from 14 December 1989 and 21 December 2001.  There was not a VA Compensation and Pension examination proximate to separation.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the MDD at 10% coded 9434, depressive disorder.  The VA also coded the condition at 9434, but rated it at 30% using the STRs.  The Board noted that the MH condition was not secondary to a traumatic event and that VASRD §4.129 is not applicable.  It observed that the CI continued to work in his AFS and was noted to be a stellar performer by the commander and as documented in the annual performance report.  The CI retained access to classified information until near separation and received an end-of-tour AF Commendation Medal.  While it is clear that he endorsed a number of symptoms, the functional impact of these was minimal.  He excelled at work and was found medically disqualified (and separated) due to the risk of future hospitalization and no longer being world-wide qualified.  The use of Zoloft justifies the 10% rating adjudicated by the PEB.  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 MDD condition.
Contended PEB Conditions. The CI also contended for the hypertension condition.  The PEB did not adjudicate the hypertension, an implied determination that it was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The hypertension was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  It was well controlled on medications.  No complications from hypertension were noted.  The hypertension condition was reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that it significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend that the contended hypertension condition be added as an unfitting condition and so no additional disability rating is recommended.

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 MDD condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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	
Major Depressive Disorder	9434	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130906, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXX, DAF
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-01212.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

XXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings