RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:                         BRANCH OF SERVICE:  AIR FORCE
CASE NUMBER:  PD201000460               SEPARATION DATE:  20010105
BOARD DATE:  20110816                     DATE PLACED ON TDRL:  20010106
                       removed from TDRL:  20020806
____________________________________________________________________________
__

SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered individual (CI) was a  Reserve  MSgt/E-7  (W071A,
Weather Forecaster) medically separated from the Air  Force  in  2002.   The
medical basis for the separation was major depressive disorder  (MDD).   The
CI had a ten-year history  of  depressive  symptoms,  temporally  associated
with seasonal changes.  In April 2000, he attempted suicide,  was  issued  a
permanent H2,  S4  profile  in  September  2000,  and  underwent  a  Medical
Evaluation Board (MEB).  MDD was  the  single  diagnosis  forwarded  to  the
Physical Evaluation Board (PEB) as medically unacceptable  IAW  AFI  48-123.
No additional conditions were present in the  Disability  Evaluation  System
(DES) file, but arthralgias and  erectile  dysfunction  were  noted  on  the
Temporary Disability Retired List (TDRL) evaluation.  The Secretary  of  the
Air Force Personnel Council placed the CI on TDRL effective 5 January  2001.
 The re-evaluation  on  17  April  2002  revealed  remission  of  depressive
symptoms, but an ongoing risk of suicide based upon his prior  history.   An
Informal PEB (IPEB) adjudicated the MDD condition as unfitting,  rated  10%,
with  application  of  the  Veterans’  Administration  Schedule  for  Rating
Disabilities (VASRD) and recommended separation.  The CI initially  appealed
the IPEB’s decision, but later waived his request for a Formal PEB.  He  was
then  medically  separated  with   a   10%   combined   disability   rating.
Subsequently, he appealed to the Air Force Board for Correction of  Military
Records (AFBCMR), requesting to be  medically  retired,  or  be  allowed  to
retire from the Reserve at 60 years of age; both requests were denied.


CI CONTENTION:  “In accordance with 10  USC  38,  §  4.126,  ‘...the  rating
agency shall consider the frequency, severity, and duration  of  psychiatric
symptoms,  the  length  of  remissions,  and  the  veteran’s  capacity   for
adjustment  during  periods  of  remission...’   The  Air  Force  failed  to
consider these factors and instead, in a rush-to-judgment,  relied  for  its
decision on a single global assessment  of  functioning  (GAF)  score.   The
assigned  GAF  score  of  65  was  absurdly  high,  and  should  have   been
immediately suspect.  As I was  on  TDRL  at  the  time,  a  reasonable  and
prudent course of action for the Air Force Physical Evaluation  Board  would
have been to question the suspect reading and order a new  test,  preferably
by a more skilled and experienced clinician.  Alternatively, the  PEB  could
have chosen to wait until the next  scheduled  evaluation,  to  see  if  the
anomalously high and suspect readings continued.   These  alternatives  were
never considered, and the suspicious GAF score was  never  questioned.   The
PEB operated with a  rush-to-judgment  mind-set.   The  PEB's  priority  was
getting a RAPID disposition, NOT getting the CORRECT disposition.  Time  and
actual clinical  experience  has  proven  the  VA's  rating  of  70%  to  be
medically sound, and the Air Force PEB's rating of 10%  to  be  unsound  and
indefensible.  According to DoD and VA guidance, the Air Force PEB's  rating
should have been not less than 50%.  I respectfully request  this  error  be
corrected.”
RATING COMPARISON:

|Final Service IPEB – Dated 20020424   |VA ( 2 mo post sep) – All Effective|
|                                      |20010106                           |
|Condition                             |Code                               |
|Total:  10%                           |Total:  70%                        |


ANALYSIS SUMMARY:

Major Depressive Disorder.  While stationed  in  Germany  in  1999,  the  CI
first sought medical care for depressive symptoms.  These had  been  present
for around ten years, but worsened  with  the  winter  climate  of  northern
Europe.   On  4  April  2000,  he  took  38  Elavil  tablets.   This  was  a
potentially lethal overdose, and he was admitted to a German hospital  after
he was discovered unconscious by his daughter.  The CI stated  that  it  was
not his intent to kill himself, and that he tried to  induce  vomiting  once
he realized what he had  done.   However,  this  was  considered  a  suicide
attempt in the face of ongoing therapy and MEB/PEB was recommended.  At  the
time of TDRL entry on 6 January 2001, he noted anxiety attacks and  that  he
“lost control” and would start crying sometimes for  hours,  and  could  not
concentrate.  He was depressed, had decreased sleep, pleasure, interest  and
appetite.  There was also intermittent suicidal ideation.  On exam,  he  was
noted to be dysthymic with intact  thought  processes,  cognition,  insight,
and judgment.  He was noted to be improved on Prozac,  and  the  dosage  was
being increased, in the hope of  further  improvement.   A  GAF  of  54  was
assigned, consistent  with  moderate  symptoms  or  moderate  difficulty  in
social, occupational, or school  functioning.   The  IPEB  recommended  TDRL
placement at 30% disability, which he began on 6  January  2001.   The  next
TDRL  evaluation  was  17  April  2002,  three-and-a-half  months  prior  to
separation (TDRL exit).   At  that  time,  the  depression  was  under  good
control on Prozac and Ambien, and  he  was  working  at  Buckley  AFB  as  a
weather forecaster.  He reported  good  energy,  interest  (in  activities),
concentration, and  appetite.   There  were  no  feelings  of  hopelessness,
helplessness, or worthlessness.  He performed aerobic activities and  weight
lifting.  His home life and relationship with his children  were  good.   On
mental status exam, he was noted to be slightly dysphoric with a  restricted
affect.  Memory and thought processes were intact, and judgment and  insight
were fair.  There were neither hallucinations,  nor  suicidal  or  homicidal
ideation.  His profile was improved to an S3 from an S4 at TDRL entry.   His
GAF was assessed at 65, which correlates with “some mild  symptoms  or  some
difficulty in social, occupational, or  school  functioning,  but  generally
functioning pretty well, has some meaningful  interpersonal  relationships.”
Although good control of his depression was noted, he was thought to  be  at
significant risk for recurrent symptoms, including  suicidal  ideation  from
the stress of military service, and  separation  was  recommended.   The  VA
compensation and pension (C&P) exam was done 19 September 2002, seven  weeks
after separation.  The CI continued to work at  Buckley  AFB  as  a  weather
forecaster and generally got along well with his wife.  He  noted  that  his
depression typically worsened from September to March or  April.   He  noted
that the combination of his separation from the service  and  the  onset  of
the fall season caused an exacerbation of his  depression.   It  had  become
quite severe.  He had not been  in  outpatient  treatment  since  separation
from TDRL (only seven weeks).  He noted fatigue,  decreased  motivation  and
concentration, exhaustion at  the  end  of  the  day,  crying  spells,  poor
libido, poor sleep, poor appetite, and  recurrent  suicidal  ideation  which
was controlled by concern for his children.  On mental status exam,  he  was
dressed neatly, appeared downcast,  and  moved  slowly.   He  had  poor  eye
contact and appeared depressed.  His affect was constricted  and  restricted
to sad tones.  He talked slowly and in a low voice and was preoccupied  with
his feelings of despair  and  hopelessness.   Orientation  and  memory  were
normal including knowledge of current events.  While slow, he  was  able  to
concentrate adequately to perform  serial  sevens,  spell  WORLD  backwards,
draw  interlocking  pentagons  and  interpret  similarities   and   proverbs
accurately.  Judgment was “clouded,” but his  insight  good.   The  examiner
noted, “currently, with the onset of the fall season, having been  separated
from the Air Force in August of this year, his depression  has  gotten  much
worse.  I am concerned about his potential suicidality and his not being  in
any  current  treatment  situation  now.”   His  GAF  was  assessed  at  45,
indicative  of  serious  symptoms  or  any  serious  impairment  in  social,
occupational, or school functioning.  The Board  then  considered  the  most
appropriate fit using VASRD §4.130 criteria for both TDRL  entry  6  January
2001 and for the appropriate permanent disability rating  at  TDRL  exit  (6
August 2002).  The latter is bracketed by  two  exams:  the  PEB  evaluation
prior to TDRL exit and the  VA  psychiatric  rating  evaluation  after  TDRL
exit.  The VA examination is closest to the time  of  final  separation  and
has the  highest  probative  value.   The  2002  medical  records  from  his
civilian medical provider, which cover the TDRL period, were requested,  but
were not available.  The Board considered the TDRL entry rating of  30%  and
discussions revolved about either a 30 or 50% rating.  He was working  again
as a forecaster, but reported a poor marital  relationship,  with  no  close
friends.   His  symptoms  were  improved   on   medications.     After   due
deliberation in consideration of the totality of  the  evidence,  the  Board
concluded  that  the  best  fit  is  the  description  for  a   30%   rating
(occupational  and  social  impairment  with  occasional  decrease  in  work
efficiency and intermittent periods of  inability  to  perform  occupational
tasks  [although  generally   functioning   satisfactorily,   with   routine
behavior,  self-care,  and  conversation  normal])  and   that   there   was
insufficient cause to recommend a change from the PEB  fitness  adjudication
for the recurrent depression condition.

The Board then considered the permanent rating.  The PEB and VA  both  coded
the depressive disorder as 9434 (MDD).  The  PEB  rated  the  disability  at
10%, whereas the VA awarded 70%.  The Board noted  that  while  the  CI  did
have a dysphoric mood and continued the use of Ambien for sleep  impairment;
he was working and had a harmonious marital relationship.   The  Board  also
noted  that  the  VA  exam  after  TDRL  exit  demonstrated  a   significant
impairment.  The Board considered whether the higher probative value due  to
proximity to TDRL exit, but noted that the VA  examiner  clearly  documented
that his depression had worsened after TDRL exit and with the onset of  fall
continued to work without documented impairment.  The  Board  also  reviewed
the AFBCMR discussion of this question and considered  the  cyclical  nature
of the CI’s symptoms and the consistent recurrence of severe depression  and
worsening  of  the  major  depressive  episodes  over   time.    After   due
deliberation, in consideration of the totality of the  evidence,  the  Board
concluded, by a 2:1 vote, that there was insufficient cause to  recommend  a
change from the  PEB  fitness  adjudication  for  the  recurrent  depression
condition.  The minority voter  advocated  for  a  30%  rating  due  to  the
severity of symptoms during fall and winter.

Remaining Conditions.  Other conditions identified  in  the  DES  file  were
arthralgia and erectile dysfunction.  Neither  condition  was  profiled  nor
implicated in the commander’s statement.  These conditions were reviewed  by
the action officer and considered by the  Board.   It  was  determined  that
none could be argued as unfitting and subject  to  separation  rating.   The
Board therefore has no reasonable  basis  for  recommending  any  additional
unfitting conditions for separation 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.  In the matter  of  the  unfitting  depressive
condition, the Board recommends, by  a  2:1  vote,  no  change  in  the  PEB
adjudication  for  TDRL  entry  or  exit  as  follows:  The  minority  voter
recommended a 30%  adjudication,  but  elected  not  to  submit  a  minority
opinion.  In the matter of the arthralgia and erectile  dysfunction  or  any
other  medical  conditions  eligible  for  Board  consideration,  the  Board
unanimously agrees that it  cannot  recommend  any  findings  of  unfit  for
additional rating at separation.


RECOMMENDATION:   The  Board  therefore  recommends   that   there   be   no
recharacterization of the CI’s disability and separation  determination,  as
follows:

|UNFITTING CONDITION                   |VASRD CODE  |TDRL    |PERMANENT  |
|                                      |            |RATING  |RATING     |
|Major Depressive Disorder             |9434        |30%     |10%        |
|COMBINED    |30%     |10%        |


The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20100311, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.





                                        President
                                                                    Physical
Disability Board of Review
SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, NAF-Washington, MD  20762



      Reference your application submitted under the provisions of DoDI
6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2010-00460.

      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
with severance pay.

      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,






                                       Director
                                       Air Force Review Boards
                                       Agency

Attachment:
Record of Proceedings