Search Decisions

Decision Text

AF | PDBR | CY2012 | PD2012 01517
Original file (PD2012 01517.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:   BRANCH OF SERVICE: Army
CASE NUMBER: PD1201517   SEPARATION DATE: 20030401
BOARD DATE: 20130423


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (91E/Dental Assistant), medically separated for major depressive disorder (MDD), recurrent, compounded by alcohol dependence, with history of depressed mood and anxiety. The CI first presented to military mental health in the late 80’s and noted first being treated for alcoholism in Germany in 1997 for both narcotic addiction and polydrug dependence to include alcohol and cocaine. The Medical Evaluation Board (MEB) was issued when it became evident that both mood disorder and alcohol dependence behaviors had interfered sufficiently to warrant command interests in separating the CI from the US Army. The CI did not improve adequately with treatment to meet the physical requirements of her Military Occupational Specialty (MOS). She was issued a permanent S4 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded MDD, moderate, recurrent w/prominent anxiety; and alcohol dependence in partial remission, as medically unacceptable IAW AR 40-501. Eating disorder and pathological gambling were identified as not ratable, medically acceptable; and an Axis II condition, cluster B personality traits, was also identified and forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated MDD, recurrent compounded by alcohol dependence, with history of depressed mood and anxiety as unfitting, rated 10%, with application of AR 635-40, Appendix B-107, Paragraph e. The PEB adjudicated alcohol dependence, the eating disorder, pathological gambling, and the Axis II diagnosis as not unfitting, not rated. The CI made no appeals, and was medically separated.
CI CONTENTION: The CI states: “Alcoholism/hearing loss, left ear, back injury. Alcoholism is a recognized disease by the A.M.A. Hearing loss has increased since I’ve been out of the military. Injured my back and it has gotten worse.” [sic]


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44 Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The rating for the unfitting condition of MDD will be reviewed. The other requested conditions of hearing loss and back injury are not within the Board’s purview. Alcoholism is a condition not constituting a physical disability IAW DODI 1332.38, Encl 5 and will not be discussed further except as it relates to the unfitting MDD condition. 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 Army Board for Correction of Military Records.


RATING COMPARISON :

Service PEB – Dated 20030207
 VA* – All Effective Date 20030402
Condition
 Code Rating Condition Code Rating Exam
MDD, Recurrent Compounded by Alcohol Dependence, w/History of Depressed Mood & Anxiety 9434 10% Depression 9434 50% STRs
Alcohol Dependence Not Unfitting Alcoholism 9399-9326 NSC STRs
Eating Disorder Not Unfitting No VA Entry STRs
Pathological Gambling Not Unfitting No VA Entry STRs
Axis II: Cluster B Personality Traits Not Unfitting No VA Entry STRs
↓No Additional MEB/PEB Entries↓
 Bacterial Vaginitis 7611 0% STRs
Fibroidal Cysts in Breasts 7699-7628 NSC STRs
Flat Feet Problems 5276 NSC STRs
Combined: 10%
 Combined: 50%
* CI failed to report for 4 VA Exams . STR=Service Treatment Records


ANALYSIS SUMMARY:

Major Depressive Order (MDD). The narrative summary (NARSUM) notes the CI had a long history of depression, over 20 years, prior to separation, and preceding documented evidence of her excessive use of alcohol. At one point the CI stated her mother was schizophrenic and had been on Lithium. The CI also had a history of using alcohol to mitigate anxiety and depression, especially in the 15 years prior to separation. She underwent treatment for alcohol, narcotic and cocaine dependence in 1997. In 1999, she was hospitalized at Landstuhl for alcoholism, with Axis II diagnoses of gambling disorder and eating disorder. In November 2000, she was treated for depression for the first time, with a sequential variety of antidepressants, and by 2001 she was going to Alcoholics Anonymous successfully, while under psychotherapy for “presumed childhood sexual abuse.” She overdosed on Prozac 5 October 2002, 6 months prior to separation, after increased suicidal ideation, and relapse into alcoholism. She apparently cited stress issues with her son as the cause for her relapse. After inpatient therapy from October 2002, she showed compliance at outpatient therapy and in taking her Zoloft and Lithium. By December 2002, the CI relapsed into compulsive gambling and an eating disorder characterized as bulimia. In January 2003, 3 months prior to separation, she had “occasional thoughts of being dead” and was almost hospitalized again. Her command evaluated her overall performance and her continued status as an impaired provider, given her MOS as a dental hygienist, and began consideration of separation for Chapter 9 rehabilitation failure, but her psychiatrist intervened to point out her underlying MDD and personality disorders beyond simple alcohol dependence disorder. On 7 January 2003, 3 months prior to separation, the CI was permanently profiled S4 (only) “major Depressive disorder, moderate, recurrent, 296.32; alcohol dependence, recurrent, 303.90, partial remission.” The following day, her commander’s letter stated her “disability impacts the performance her duties in her primary MOS of 91E in the following manner: a. … difficulty in concentrating and focusing on a given task. b. Manic mood swings from cheerful to sad and in tears creates a barrier of trust in leadership ability … also creates a barrier to communication with patients and co-workers because of a tendency to shut down or become extremely angry at times. c. During inspections or even verbal counseling from Senior NCOs and supervisors, has difficulty receiving criticism whether positive or negative. d. Extremely overwhelmed in current duty position …. Completing multiple tasks is a constant source of stress. e. She is enrolled in the Impaired Provider Program through Alcohol, Substance Abuse Program, which prohibits her from working in primary MOS as a Dental Assistant involving patients. f. Displays a lack of motivation in complying with directives and deadlines from superiors. g. Trust in leadership ability from junior enlisted has diminished because of depressive condition. She is unable to motivate soldiers due to a decline in both physical fitness and appearance. h. She would be considered a safety risk to self and others if required to participate in yearly weapons qualification because of emotional instability.”

Her commander also noted she had no Uniform Code of Military Justice (UCMJ) actions in the prior 2 years and that her “duty performance is unsatisfactory to satisfactory at times. Her physical impairments prevent her from fulfilling MOS requirements. Her illness does prevent this unit from utilizing her in a productive manner.” Her commander recommended immediate processing and separation from the US Army. At the January 2003 MEB exam, the CI reported she was “active in her recovery program through Alcoholics Anonymous, and reported compliance with her Zoloft and Lithium medications. She stated she had a sponsor, and was working her Alcoholics Anonymous program. She did admit to a single drink on Christmas, but denied alcohol use other than that since October 2002. She reported, however, recently compulsive gambling and eating disorder symptoms consistent with eating large volumes of food and throwing them up and apparently spending December's paycheck on scratch-off lottery-type tickets. She denies significant financial problems and/or metabolic or other disturbances from these two other impulsive/compulsive behaviors.” At the MEB physical exam, the examiner (a psychiatrist) noted “her response overall to treatment has been complicated by the dual nature of both her apparent mood disorder and alcohol and addictive behaviors; however, her work function over the last 16 years has apparently been satisfactory.” The examiner stated her diagnosis as:

“Major depressive disorder, moderate, recurrent (296.32) with prominent anxiety symptoms. Severity: Severe. Chronicity: Chronic. Manifested by chronic feelings of uptightness and anxiety, depression, chronic feelings of despair and hopelessness and low self-esteem, mood lability, evident both in workplace and at home, chronic feelings of loneliness, difficulty concentrating, guilt, anger and rage, a sense of loss of control not only including the patient's use of alcohol, gambling and eating behaviors, recent nightmares, continued problems in relationships, problems with her son and feeling financial strain as a result of pending separation from the United States Army. She notes chronic thoughts of death as a solution to her problems, but "is not really suicidal." Predisposition: Moderate, consistent family history of some sort of mood disorder. Impairment for military duty: Marked. Impairment for social and industrial adaptability: Considerable. Line of duty: Yes. Service aggravated: No. Date of onset: Late 80's. Intermittent course, recently exacerbated in the last 1 1/2 years.”

The CI failed to report for VA Compensation and Pension (C&P) exams after separation and the VA based her disability on her service treatment record (STR). The VA rating decision summarized the NARSUM exam as: “(the CI) reported feelings of anxiety, depression, despair and hopelessness, with difficulty concentrating, nightmares and mood lability. (The CI’s) mental status examination (MSE) showed speech was normal, affect consistent with moderately depressed. (The CI’s) thought processes were linear and logical. (The CI) denied suicidal and homicidal ideation, delusions, and auditory and visual hallucinations. Memory was good and concentration showed no evidence of defects. The examiner estimated (the CI’s) Global Assessment of Functioning score to be 50 indicating serious manifestations of symptoms. The examiner noted considerable impairment for both social and industrial adaptability.”

The Board directs attention to its rating recommendation based on the above evidence. The service rated her “major depressive disorder, recurrent compounded by alcohol dependence, w/history of depressed mood & anxiety” under §4.130 as 9434 (major depressive disorder), and rated 10%; “responsive to mood stabilizer and lithium. Rated as mild social industrial impairment IAW AR 635-40, Appendix B-107, Paragraph e.” The VA assigned her the same diagnosis and code, but rated 50% using the service records as noted above. First, the Board noted that the CI’s depression in all likelihood preceded her alcoholism according to the STR. There is no methodology for applying, or means of measuring, any deduction which might be considered. The Board must therefore disregard the influence of either alcohol/substance abuse or non-compliance on ratable symptoms for its permanent rating recommendation. The Board noted there was no highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress. The Board agreed the diagnosis code 9434 best fit the CI’s ratable illness under §4.130. The Board opined the NARSUM was the most proximate and only exam temporally close to separation and had the greatest probative value for rating. The Board proceeded to rate under §4.130 and compared the NARSUM opinion of the CI’s employability and work function and the commander’s statement of duty performance. The CI’s illness did not rise to the level of 70% disability characterized by occupational and social impairment, with deficiencies in most areas, and exceed the 10% mild/transient symptom level. Deliberations focused on the 30% versus 50% rating levels as the record supported symptoms waxing and waning over a multi-year period (“intermittent course”) with exacerbation in the year and a half prior to the NARSUM. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), and the application of §4.130, the Board majority recommends a disability rating of 30% for the MDD condition.

Contended PEB Conditions. The contended condition adjudicated as not unfitting and not ratable by the PEB was alcohol dependence in partial remission. Uncomplicated alcoholism is a condition not constituting a physical disability IAW DODI 1332.38, Enclosure E., and is not compensable. There was no evidence of complications of alcohol dependence. The Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination, and therefore no additional disability ratings can be recommended.
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. As discussed above, PEB reliance on AR 635-40 for rating MDD and alcohol dependence in partial remission was operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the MDD condition, the Board by a vote of 2:1 recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130. The single voter for dissent (who recommended a 50% rating) did not elect to submit a minority opinion. In the matter of the contended alcohol dependence in partial remission condition, the Board unanimously recommends no change from the PEB determination as not unfitting (not compensable). There were no other conditions within the Board’s scope of review for consideration.
RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Major Depressive Disorder Condition 9434 30%
COMBINED
 30%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120814, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20130010211 (PD201201517)


1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

         a. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

         b. Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

         c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

         d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2014 | PD-2014-03325

    Original file (PD-2014-03325.rtf) Auto-classification: Denied

    The MEB forwarded the following Axis I conditions to the Physical Evaluation Board (PEB) IAW AFI 48-123 and 44-113:“maj depressive disorder/recurrent/moderate; anxiety disorder NOS; alcohol dep.” The MEB also forwarded “borderline personality traits” as an Axis II condition.No other conditions were submitted by the MEB.The PEB adjudicated the referred Axis I conditions, less the alcohol dependence condition, as a single unfitting condition (for rating purposes), “major depressive disorder...

  • AF | PDBR | CY2013 | PD-2013-01338

    Original file (PD-2013-01338.rtf) Auto-classification: Denied

    On admission the CI reported worsening depression and anxiety symptoms, auditory hallucinations of people calling her name and anger episodes involving hurting herself, though she denied SI or homicidal ideation (HI). 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...

  • AF | PDBR | CY2014 | PD-2014-00430

    Original file (PD-2014-00430.rtf) Auto-classification: Denied

    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. Post-Separation) ConditionCodeRatingConditionCodeRatingExam Major Depressive Disorder943410%Major Depressive Disorder943430%20060613Other MEB/PEB Conditions x 0 (Not In Scope)Other x 0 RATING: 10%RATING: 30% *Derived from VA Rating Decision (VARD)dated 20060613 (most...

  • AF | PDBR | CY2013 | PD-2013-01644

    Original file (PD-2013-01644.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation: I have carefully reviewed the evidence of record and the...

  • AF | PDBR | CY2012 | PD2012 01874

    Original file (PD2012 01874.rtf) Auto-classification: Denied

    She also alleged emotional, physical and sexual abuse,and stalking,prior to entry in the service (age 19) by a boyfriend.The admission mental status exam(MSE) noted depressed mood, normal thought process, and no auditory or visual hallucinations.The discharge diagnoses on Axis I: MDD;Axis II: Cluster B traits (borderline, histrionic, narcissistic and/or antisocial); and, Global Assessment ofFunctioning (GAF) of 65 (some mild symptoms or impairment).At the narrative summary NARSUMexamon 24...

  • AF | PDBR | CY2012 | PD2012 00998

    Original file (PD2012 00998.rtf) Auto-classification: Denied

    Separation Date: 20031215 The Board also notes that a C&P exam performed 24 months after separation documents that the CI’s mental health diagnosis was changed to Bipolar disorder sometime after her separation from military service while receiving treatment from the VA. I have carefully reviewed the evidence of record and the recommendation of the Board.

  • AF | PDBR | CY2012 | PD2012-00122

    Original file (PD2012-00122.docx) Auto-classification: Denied

    The Board evaluates DVA evidence proximal to separation in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness decisions and rating determinations for disability at the time of separation. The examiner diagnosed bulimia nervosa, dysthymic disorder, major depressive disorder, recurrent, in partial remission, dependent personality traits and poor family support with a history of multiple sexual assaults, and occupational stress. Other PEB...

  • AF | PDBR | CY2014 | PD-2014-01598

    Original file (PD-2014-01598.rtf) Auto-classification: Approved

    SEPARATION DATE: 20081107 The CI was also diagnosed with an adjustment disorder and a personality disorder that the PEB “found to be not compensable, although they may be administratively unfitting.” This case is eligible for review under the stipulations of the MH and Review Program as elaborated in the Scope above and, in accordance with VASRD 4.130 (mental disorders), only one disability rating may be provided for MH (except eating disorders) based upon total social and occupational...

  • AF | PDBR | CY2011 | PD2011-00817

    Original file (PD2011-00817.docx) Auto-classification: Denied

    The CI was on four medications. Although at the time of the NARSUM (4 months prior to separation), a case could be made for a 50% rating for continuous occupational and social impairment with reduced reliability and productivity, the record indicated some improvement in functioning proximate to separation and partial remission by the VA C&P after separation exam. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows and that the discharge with...

  • AF | PDBR | CY2014 | PD 2014 01477

    Original file (PD 2014 01477.rtf) Auto-classification: Approved

    The psychiatric addendum to the NARSUM is dated 31 July 2008 (10 days following above admission, preceding later STR evidence just cited, and ~12 months pre-separation). It documents a baseline pain rating of 6/10 “increasing to 9-10/10 with activity.” The physical exam noted trochanteric tenderness and provided the ROM measurements charted below.The post-separation (10 months) VA C&P evaluation documented “fell on hip yesterday is having extreme bilateral hip pain and is unable to walk.”...