RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01975
BRANCH OF SERVICE:  Army	BOARD DATE:  20140821
DATE OF PLACEMENT ON TDRL:  20040501
Date of Permanent SEPARATION:  20060614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (15N/Avionic Mechanic) medically separated for major depressive disorder (MDD).  The MDD condition did not improve adequately to meet the requirements of his Military Occupational Specialty.  He was issued a permanent S4 profile and referred for a Medical Evaluation Board (MEB).  “Major depressive disorder, recurrent, severe” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) found the MDD condition unfitting, but not sufficiently stable for permanent adjudication.  The CI was placed on the Temporary Disability Retirement List (TDRL) with a disability rating of 30%.  In April 2006, 2 years later, another IPEB was convened.  The CI remained unfit and was stable for permanent adjudication.  The MDD was rated at 10%.  The CI made no appeals at that time.  On 14 June 2006, he was removed from the TDRL and medically separated with a permanent disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”

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 MDD is addressed below; and, 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 Board for Correction of Military Records.

RATING COMPARISON:

Final Service PEB - 20060426	VA (STR Used) - Effective 20040501	
On TDRL - 20040501	Code	Rating	Condition	Code	Rating	Exam	
Condition		TDRL	Sep.					
Major Depressive Disorder	9434	30%	10%	Major Depressive Disorder	9434	30%	STR	
Other x 0 (Not in Scope)	Other x 9	STR	
Rating:  30% → 10%	Combined: 40%	
        *Reflects VA rating exam proximate to TDRL placement; no VA rating evidence proximate to permanent separation

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Major Depressive Disorder (MDD).  The CI has had a long history of mental health (MH) problems.  In 1997, he was found unfit and was placed on TDRL.  In April 1999, after 2 years of TDRL, he was found fit and returned to duty.  However, his psychiatric symptoms recurred.  In October 2000, he was hospitalized at Fort Campbell due to MDD.  In March 2003, the CI deployed to Iraq.  A few months later, he was evacuated from theater due to MH symptoms.  After his return to Fort Campbell, the MH problems continued.  In October 2003, the CI attempted suicide by swallowing pills and cutting one wrist.  He was admitted to Blanchfield Army Community Hospital (BACH), where he received 3 weeks of inpatient psychiatric treatment.  Due to the chronic, recurring nature of his MDD, another MEB was initiated in November 2003.  At that exam, the CI admitted being unable to perform his military duties, but felt a strong need to continue serving in the Army.  Three friends had recently died in a helicopter crash in Iraq.  His principal complaints were related to difficulties with his marriage, poor sleep, and a 40-pound weight loss.  The CI reported problems with energy, concentration, and feelings of worthlessness/guilt.

On mental status exam (MSE), he was alert and cooperative, but inappropriately slouching in his chair.  There was no psychomotor agitation or retardation and speech was clear.  His stated mood was “sad, moody, and stressed.”  Observed affect was consistent with that.  He appeared uncomfortable.  Thought processes were linear, logical and goal directed.  Thought content was that he specifically denied suicidal ideation at that time, but was able to endorse recent suicidal ideation when discussing the stresses in his marriage and subsequent divorce.  He admitted to “people talking to me,” however, this appeared to be in a clear sensorium and unlikely suggestive of a psychotic lapse.  It was unclear the significance of these repeated symptoms.  Memory was intact.  Concentration was fair.  Fund of knowledge was average.  Judgment and insight were adequate.  Overall, he appeared cooperative and reliable.  The examiner’s Axis I diagnosis was: MDD, recurrent, severe, with history of psychotic features; psychotic features apparently resolved.  The impairment for social and industrial adaptability was “considerable.” The Axis V Global Assessment of Functioning (GAF) score was 55.  In January 2004, the CI was found unfit, but the mental condition was not sufficiently stable for permanent adjudication.  He was placed on the TDRL with a temporary disability rating of 30% effective on 1 May 2004.

The Board carefully examined all available evidence and determined that a higher rating at that time was not warranted.  The CI’s mental disorder was not the result of a highly stressful event, so VASRD §4.129 (mental disorders due to traumatic stress) did not apply.  Furthermore, IAW the VASRD §4.130, General Rating Formula for Mental Disorders, a rating of 50% would require occupational and social impairment, with reduced reliability and productivity due to such symptoms as: flattened affect, abnormal speech pattern, panic attacks, difficulty understanding commands, impaired memory, impaired judgment, impaired thinking, disturbances of motivation and mood, or difficulty in work and social relationships.  Since the treatment record did not show sufficient evidence of these findings, the Board had no basis to recommend a rating higher than 30% when he was placed on TDRL.  In April 2006, after almost 2 years on TDRL, the CI had a psychiatric evaluation at BACH, Fort Campbell, Kentucky.  At that visit, he reported that he was employed full-time.  He was working 10-12 hours per day, usually 5 or 6 days per week.  He visited his ex-wife and children fairly frequently, at their home in Clarksville, Tennessee.  The CI reported problems with decreased energy, feelings of guilt/worthlessness, lack of enjoyment, suicidal ideation, poor concentration, insomnia, depressed mood and poor appetite.  He was not taking any medication or receiving any MH treatment.  
He had not seen a counselor, therapist, or physician since July 2004.  He had not taken any medications for 2-3 months.

On MSE, he was cooperative, appropriately dressed and had fair eye contact.  There was mild psychomotor retardation.  His speech was moderately soft and slow.  His mood was moderately depressed and he showed mild anxiety.  Affect was flat.  Thought processes were linear and goal-directed.  Thought content was appropriate to the examiner's questions.  There was a history of intermittent suicidal ideation, primarily associated with periods of increased stress.  He reported no homicidal ideation.  There was no evidence of illusions or delusions.  He reported he heard a vague voice calling his name whenever he was severely stressed.  These were more like altered states than true hallucinations.  His insight and judgment were fair.  Cognition was grossly intact.  The examiner’s Axis I diagnosis was MDD, recurrent, moderately severe.  Impairment for social and industrial adaptability was mild.  The GAF score was not recorded.  The examiner recommended that the CI be re-evaluated in 12-18 months, so more information could be obtained to determine the course of the CI’s illness.  On 26 April 2006, an IPEB was convened and recommended permanent separation due to MDD, recurrent.  In June 2006, the CI was removed from TDRL and permanently separated from military service.

The Board directed its attention to its rating recommendation based on the evidence in the record.  The best source of information on which to base the permanent disability rating is the April 2006 MH exam performed just 2 months prior to separation.  At that time, he was working 50-70 hours per week and was visiting his ex-wife and children fairly frequently.  He was not taking medication or receiving any MH treatment.  On MSE, the CI’s thought processes were linear and goal-directed.  Thought content was appropriate to the examiner's questions.  There was no evidence of illusions or delusions.  His insight and judgment were fair.  Cognition was grossly intact.  It was clear that the CI was having MH symptoms, but apparently he was functioning well.  This was evidenced by his effective employment and the visits with his children, which were fairly frequent.  The Board could find no evidence of serious difficulties with job performance or interpersonal relationships.  The CI’s impairment for social and industrial adaptability (which had previously been described as “considerable”) was “mild.”  With regard to the psychiatric rating recommendation, all Board members agreed that 10% was appropriate.  The Board determined that the CI may experience decreased work efficiency and decreased ability to perform certain tasks, during periods of significant stress.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the adjudication of the MDD condition.  It is appropriately coded 9434, was IAW VASRD §4.130 and met criteria for the 10% rating level.

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 20140507, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20150008221 (PD201401975)

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		     XXXXXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA