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AF | PDBR | CY2012 | PD2012 01187
Original file (PD2012 01187.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201187
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130724
SEPARATION DATE: 20020703


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty (Reserve) ENS/O-1 (1165/Assistant Training Officer) medically separated for major depressive disorder (MDD). Records indicate the CI had a lifelong history of difficulty with interpersonal relationships. The CI reported she had significant difficulties with interpersonal conflicts and had a physical altercation with another junior officer. The CI participated in therapy and medication management. She underwent psychological testing and was diagnosed with depressive disorder, not otherwise specified, and borderline and paranoid traits. Despite medication and therapeutic intervention, her MDD could not be adequately rehabilitated to meet the physical requirements of her rating or satisfy physical fitness standards. She was placed on limited duty (LIMDU) and then referred for a Medical Evaluation Board (MEB). “Major Depressive Disorder recurrent, moderate, severe, EPTE, not service aggravated” was forwarded to the Informal Physical Evaluation Board (IPEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The CI non-concurred with the MEB’s comment of “not service aggravated” and the diagnosis was changed to indicate service aggravation. The IPEB adjudicated “major depressive disorder” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The PEB indicated a pre-existing condition, but did not reduce the rating. The CI demanded a Formal PEB (FPEB) but subsequently accepted the IPEB findings and waived her right to an FPEB and was medically separated.


CI CONTENTION: “I was separated JFL. I was assaulted by another officer on my ship. After reporting the incident to my chain of command I was told by the XO it was “my fault”. The physical assaults continued throughout my deployment. I wrote a letter to my psychiatrist explain the horrible terrifying experience and he recommended I be medically discharged with severance.”


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 Naval Records.


 RATING COMPARISON :

Service IPEB – Dated 20020204
 VA - (2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Major Depressive Disorder 9434 10% Major Depressive Disorder 9434 30% 20020430
No Additional MEB/PEB Entries
 NSC x 5 20020513
Rating: 10%
 Rating: 30%
Derived from VA Rating Decision (VA RD ) dated 200 20813 ( most proximate to date of separation [ DOS ] ).
ANALYSIS SUMMARY: The Board, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all Board cases as appropriate), must consider if the definition of §4.129 is 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.” If the Board judges that application of §4.129 is appropriate, it will recommend a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL). The Board must then determine the most appropriate fit with VASRD 4.130 criteria at 6 months for its permanent rating recommendation, based on the facts in evidence, which are most probative for that interval.

Major Depressive Disorder: The first entry in the treatment record is from 23 February 1999 which notes that the CI had a long history of difficulties in social relationships and a prior hospitalization at age 19 (1993) for threatening suicide, which she did not reveal in her intake physicals. She took no medications or had follow-up psychiatric care after that hospitalization. She joined the Navy on 21 May 1994. She had counseling for depression while in the Naval Academy. She informed physicians in the fall semester of her first year she had not disclosed the mental health information upon intake examinations. While at the academy, she was suspended once and then adjudicated for insubordination in a separate incident. On 23 February 1999, she was medically cleared for duty. She again denied depression and prior mental condition treatment, or any type of hospitalization during a physical for sea duty screening on 7 September 2000, and was cleared. Her condition worsened while on active duty on ship after she had conflicts with another officer in October 2000. On 2 February 2001, after a discussion with her XO that indicated she was a strong performer able to perform her duties, she was found fit for duty. On 14 March 2001, she was placed on LIMDU due to continuing problems with outbursts, refusing to participate in activities and looseness of associations in a written problem statement. She was then again hospitalized in October 2001 at Portsmouth Naval Medical Center for expressing suicidal thoughts during the MEB process. She was given medications and visited psychiatry on a weekly basis. On 14 March 2001, 16 months prior to separation, the LIMDU board examination noted the CI was alert and fully oriented, made good eye contact, well-groomed, depressed mood, congruent affect, no suicidal or homicidal ideations, limited insight and intact cognition and memory. Psychological testing resulted as a very long standing pattern of serious emotional problems and extreme difficulty with interpersonal relationships, and significant depressive and anxiety symptoms; she was given a diagnosis of Axis I: depressive disorder, Axis II: borderline and paranoid traits. The MEB examination report, dictated on 13 July 2001, 12 months prior to separation, noted interpersonal conflicts, two physical altercations while serving on ship and counseling. Examination revealed fairly good eye contact, normal speech in process and content, depressed mood at times tearful affect, no suicidal or homicidal ideations, limited insight, intact judgment, intact cognition and memory. The CI was able to perform her limited duties in a marginal way, and continued to have significant interpersonal problems. She was diagnosed with Axis I: MDD, recurrent, moderate, severe, existed prior to service, not service-aggravated. These findings were appealed and changed to service-aggravated.

The VA Compensation and Pension exam performed on 30 April 2002, 3 months prior to separation, noted a depressed affect, frequent crying, nightmares, panic attacks, insomnia and hypersomnia, inability to concentrate and forgetfulness. Global Assessment of Functioning (GAF) was 52. On a VA psychiatry initial evaluation, on 23 May 2004, 10 months after separation, the CI reported she had not been either up or down, but more down with racing thoughts, easily angered, able to sleep at night, sleepy during the day and difficulty concentrating. She was placed on medications and was able to function well. Examination revealed casual dress, neat in appearance, mild to moderately depressed, no suicidal or homicidal thoughts or plan, coherent and logical speech, oriented in all spheres, with good memory. At a psychiatric initial evaluation exam on 27 August 2003, 13 months after separation, the CI reported she had left law school after one semester, due to depression and lack of funds. She was working as a researcher since March 2003. She stated she was not in a relationship, had a few good friends and she got along with her family well. Physical examination was alert, well-groomed, neatly dressed, no psychomotor agitation or retardation, good eye contact, regular rate and rhythm of speech, logical thought processes, no psychotic symptoms, mood was somewhat depressed with a fairly blunted and occasionally irritable affect, memory and concentration appeared good, insight and judgment were fairly good, GAF 50. She expressed periods of elevated mood, and bipolar disorder, depressed, was provisionally diagnosed.

The Board examined the entire record in evidence and deliberated if VASRD §4.129 was appropriate. The majority agreed that the evidence did not warrant application of VASRD §4.129. The Board then determined the most appropriate fit with VASRD §4.130 criteria, its permanent rating recommendation at the time of discharge. Both the PEB and the VA used the same VASRD diagnostic code 9434 (major depressive disorder), which the PEB rated 10% and the VA rated 30%. All Board members agreed that the 50% threshold was not approached. The Board then considered the criteria of the 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) versus the 10% rating (occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication). The Board concluded that the CI did meet the 10% rating due to inability to perform occupational tasks during a period of significant stress due to transient symptoms.


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 recommends no change in the PEB adjudication by a vote of 2:1. The single voter for dissent (who recommended application of VASRD §4.129 and a final separation rating of 10%) did not elect to submit a minority opinion. 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, 20120620, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



xx
President
Physical Disability Board of Review

 MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 5 Nov 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- former USMC
- former USN
- former USN
- former USN


                                                      xx
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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