RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02190
BRANCH OF SERVICE:  Army  	BOARD DATE:  20150211
SEPARATION DATE:  20060505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 (Signal Support Systems Specialist) medically separated for major depressive disorder.  The condition 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 “major depressive disorder, single episode, moderate” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated major depressive disorder as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

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 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 Veterans Affairs Schedule for Rating Disabilities (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 20060414	VA* - (~8 Mos. Pre/Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder, Single Episode, Moderate…	9434	10%	Major Depressive Disorder	9434	---%	20070106	
Other x 0 (Not In Scope)	Other x 3	
RATING:  10%	RATING:  ---%	
*Derived from VA Rating Decision (VARD) dated 20060505 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Major Depressive Disorder Condition.  Service treatment records evidence that the CI presented to the acute care clinic on 06 January 2006 with reports of suicidal and homicidal ideations.  He was transferred to a hospital for an acute psychiatric evaluation.  An emergency room (ER) note documented provisional diagnoses of severe depression and anxiety.  The narrative summary (NARSUM) documented that the CI was evaluated at the emergency room, was not admitted, and was “released to Command supervision with follow-ups at Camp Shelby Behavioral Health Clinic.”  Psychiatric notes from dated 26 January 20006 and 02 February 2006 documented positive results with Prozac and decreased anxiety symptoms.  The CI was transferred to Moncrieff Army Community Hospital (Fort Jackson) for further psychiatric care while awaiting an MEB.  

The NARSUM noted that the CI’s depressive symptoms with suicidal and homicidal ideations were precipitated by his wife’s miscarriage and difficulties with his command.  At the time of the NARSUM examination the CI reported sleep disturbance, nightmares, and guilt.  He also reported impaired interests, energy, and concentration.  He continued on Prozac and Ambien.  He described a supportive marriage relationship.  The mental status examination revealed a depressed mood and constricted affect.  The examiner documented that the CI was without current suicidal or homicidal ideations.  The examiner diagnosed major depressive disorder, single episode, and moderate with a global assessment of functioning (GAF) score of 55 (moderate).  The examiner opined that the prognosis was good for full recovery with continued treatment; however, due to the relapsing nature of major depressive disorder there was the likelihood of another episode.  

At the VA Compensation and Pension (C&P) examination performed 8 months after separation, the CI reported the his depression was better with decreased stress and guilt.  The CI reported resolution of his sleep disturbance and a good appetite.  The mental status examination was normal except for a somewhat tangential thought process.  The examiner rendered a diagnosis of major depressive disorder, recurrent, in full remission with a GAF score of 70 (mild).  The examiner opined that the CI’s depression predated his time in service, but the stress related to deployment resulted in a depressive episode which resolved because the CI was no longer deployed.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB adjudicated the major depressive disorder condition as unfitting with a disability rating of 10% for mild impact on industrial and social capabilities.  The VA did not initially service-connect the major depressive disorder; however, 19 months after separation the VA rated the condition at 50%, retroactive to a day after separation.  The Board considered whether there was evidence to support a higher than 10% disability rating.  The Board noted that the NARSUM and VA examinations attributed the depressive episode to deployment and military service.  The Board noted resolving depression and anxiety symptoms prior to separation and documentation of symptom resolution at the VA examination 8 months after separation.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the major depressive disorder condition was appropriately recommended in this case.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

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 major depressive disorder 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 20140509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	
XXXXXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXXXXX, AR20150014961 (PD201402190)

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						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)