RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00430
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150610
SEPARATION DATE:  20050801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Air Transportation Journeyman) medically separated for major depressive disorder (MDD).  This condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty.  She was issued an S4 profile and referred for a Medical Evaluation Board (MEB).  “Depressive Disorder” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “major depressive disorder, recurrent, EPTS with service aggravation” as unfitting, rated 10%, citing application of Department of Defense and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I believe my disability should have been listed as PTSD and I want to know if I would have been eligible for a medical retirement.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

IPEB – Dated 20050617 | VA* - (~4 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Major Depressive Disorder | 9434 | 10% | Major Depressive Disorder | 9434 | 30% | 20060613
Other MEB/PEB Conditions x 0 (Not In Scope) | Other x 0
RATING:  10% | RATING:  30%
*Derived from VA Rating Decision (VARD) dated 20060613 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Major Depressive Disorder.  The service treatment record (STR) first noted contact with Behavioral Health in October 2002 which indicated a “poly disorder with mixed anxiety and depressed mood.”  In 2004, the CI was referred to Life Skills for counseling secondary to social, home, and occupational stressors with associated sleep disturbances.  From early 2004 through mid-2005, the CI was followed and treated for MDD and dysthymia with medications and counseling.  In regards to continued use of medications, the STR remained inconsistent in its documentation.  The last Life Skills note while on active duty was dated 15 June 2005 (6 weeks prior to separation) and noted a prescription for daily use of antidepressant medication.  The first VA treatment record dated 8 November 2005 (3 months after separation) indicated no use of medications; whereas another VA note just 2 days later clearly noted daily use of previously prescribed medication.  Overall, at 6 weeks prior to separation, the CI showed improvement in her symptomatology.  Her mental status examination (MSE) was normal and her psychological risk profile was calculated as “no significant risk.”  Her Axis I diagnosis remained MDD-recurrent/moderate.  Although the commander’s letter clearly noted that the CI’s medical condition did not affect her ability to perform her duties at her primary location, the profiled restrictions of not being world-wide qualified and thus “non-deployable” were grounds to recommend military separation.

The MEB psychiatric narrative summary (NARSUM) of 17 May 2005 (10 weeks prior to separation), noted the CI’s endorsed continued occupational and personal stressors (financial, family, and legal).  She denied manic or psychotic symptoms, anxiety or panic attacks.  Her MSE revealed a dysphoric (unhappy) mood and a labile affect (emotionally changing).  She denied hallucinations, paranoia, delusions, obsessions, compulsions, or suicidal/homicidal ideations.  Her psychiatric diagnoses included MDD, recurrent moderate; dysthymia, and problems with primary support, and social/occupational problems.  Her Global Assessment of Functioning (GAF) was 55, connoting between “serious” and “moderate” impairment.  The examiner additionally stated, “She currently has impaired functioning at work and frequently has interpersonal problems.” Her military impairment assessment was “marked” and her social and industrial impairment was assessed as “minimal.”  Under her NARSUM recommendations, the examiner made comment about the need for her to re-start medication and remain on such for a period of 5 years after full remittance of symptoms.

At the VA Compensation and Pension (C&P) examination performed on 12 December 2005 (4 months after separation), the CI reported crying spells, sleepiness, and decreased energy.  She admitted that her depressed symptoms, although still present, were less than prior to service separation.  Specifically, “The [CI] explained that she opted for an early out of the military… because of her symptoms of depression, although resolved, she was still bothered with breakthrough symptomatology.”  Her MSE was detailed and normal excepting a self-described mood as “fair” and a “mildly restricted” affect.  Her primary diagnosis remained major depression, recurrent without psychotic features as well as psychosocial stressors related to recent discharge from the military and readjustment to civilian life.  Her GAF was listed as 58-62; connoting impairment as being better than “moderate” symptoms or moderate difficulty in social, occupational, or school functioning…an improvement from nearly 6 months prior at the MEB examination.

The Board directed attention to its rating recommendation based on the above evidence.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH conditions.  Both the PEB and VA applied the clinically appropriate code 9434 (major depressive disorder) and arrived at different ratings (10% and 30% respectively) under VASRD §4.130.  The service listed the unfitting depression condition as existed prior to service (EPTS) with service aggravation and “mild” with a 10% rating.  The VA cited occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily) for a 30% rating.

The Board first considered if the definition of VASRD §4.129 was met for any psychiatric condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.”  Board members agreed that although some contribution of service stressors to the psychiatric condition were present (duty and occupational problems); the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not adequately satisfied.  The Board therefore will consider only the VASRD §4.130 impairment present at separation for a single rating recommendation.  Members then considered if there was evidence for a §4.130 rating higher than PEB’s 10% at time of separation.  In regards to examination probative value, all board members agreed that both the NARSUM and the VA C&P exams contained important physical parameters, but a higher probative value was apportioned to the NARSUM based upon its nearer time reference to separation.

In regards to the degree of occupational and social impairment, the VA indicated the condition was “moderate” (indicative of above “mild” or “transient”...10%) whereas the NARSUM specifically noted “minimal” for the degree of social and industrial impairment.  Board members agreed that the described “minimal” impairment was accurately reflected in the PEB’s final decision at 10% impairment.  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.

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.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140121, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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

Dear XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00430.

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,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR

PD-2014-00430