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AF | PDBR | CY2012 | PD2012 01738
Original file (PD2012 01738.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1201738
BRANCH OF SERVICE: NAVY  BOARD DATE: 20140416
SEPARATION DATE: 20030518


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CTM3/E4 (Petty Officer Third Class) (CTM3/Cryptologic Technician Maintenance) medically separated for a mental health (MH) condition. Her MH condition could not be adequately rehabilitated to meet the physical requirements of her rating and she underwent a Medical Evaluation Board (MEB). Her MH condition, characterized as major depressive disorder (MDD), dysthymic disorder, unspecified personality disorder; and, right shoulder pain, were forwarded to the Physical Evaluation Board (PEB) as not meeting medical standards IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated MDD as Category I (unfitting), rated 10% and personality disorder not otherwise specified and right shoulder pain was found Category III (not separately unfitting, and not contributing to the unfitting condition) with likely application of VA Schedule for Rating Disabilities (VASRD). The CI appealed and the Navy Council of Personnel Boards affirmed the PEB’s findings and then CI was medically separated.


CI’s CONTENTION: “Major Depression”


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 Category I (unfitting) MDD is addressed below. The Category III personality disorder did not constitute a physical disability and is not within the DoDI 6040.44 defined purview of the Board. The Category III right shoulder pain was not contended; and thus, is not within the Board's purview. Any condition outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Naval Records.


 RATING COMPARISON :

Navy Personnel Council – Dated 20030206
 VA* - (8.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Major Depressive Disorder 9434 10% Major Depressive Disorder 9434 10% 20040128
Personality Disorder, Not Otherwise Specified Category III
Right Shoulder Pain Category III Right Shoulder S/P Rotator Cuff Repair 5201-5203 10% 20040128
No Additional MEB/PEB Entries
 Other x 0 20040128
Combined: 10%
 Combined: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 40420 (most proximate to date of separation )


ANALYSIS SUMMARY: It is noted for the record that, 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 VASRD standards, based on ratable severity at the time of separation.

Major Depressive Disorder. In 2000, the CI started having sleep difficulties and was diagnosed with depression. The non-medical assessment, signed by her commander on 24 October 2002, stated, “…along with her physical limitations [the CI] suffers from bouts of severe depression that are compounded by her physical limitations and the stress of dealing with the staff and students in the facilities she manages. Overall her mood is fairly level but there are times of irritability. Despite recent variations of medication, her condition remains consistent [pain, depression and irritability] and she is not worldwide deployable.” In April 2001, the MEB psychiatric narrative summary (NARSUM) documented the CI received inpatient treatment for suicide ideation at the Psychiatric Unit, but evidence was not available for the Board’s review.

The CI was treated with an anti-depressant medication (Zoloft) and anti-anxiety medication (BuSpar), but her MH problem did not improve adequately, and an MEB was initiated. During her MEB psychiatric NARSUM, dated 4 September 2002 approximately 8 months prior to separation, she was administered two psychological tests: the Minnesota Multiphasic Personality Inventory and Millon Clinical Multiaxial Inventory III. The tests profiled the CI with a chronic pattern of psychological maladjustment with recurrent feelings of hopelessness, inadequacy and insecurity. Test analyses/conclusions stated the CI was functioning at a very low level of efficiency and she tended to overreact to even minor stressors. The tests offered diagnostic considerations which included major depression, dysthymic disorder, schizoid or depressive personality disorder with avoidant and self-defeating traits. Lastly, test results stated the CI was likely to become a clear suicide risk due to her chronic depressive and withdrawn condition. During the NARSUM mental status exam, the psychiatrist described the CI as alert, cooperative, well-oriented and neatly dressed. The CI’s mood was “not content, but not happy either.” The CI reported a decreased appetite, with fluctuating energy and concentration. The psychiatrist documented that she was hospitalized for suicidal ideation, but at that time she denied any current suicidal ideation or intent. The psychiatrist judged the CI’s military impairments as “severely impaired with the demonstrated inability to carry out her routine Military functions even with the benefit of psychiatric medications and regular psychotherapy.” Additionally, the psychiatrist judged her civilian industrial capacity as moderately impaired, however, medication management and psychotherapy would be critical to her continued progress. An Axis I diagnosis of MDD; severe, recurrent, without psychotic features was rendered with a Global Assessment of Functioning (GAF) score of 50 (severe). The NARSUM showed the CI on her third psychotropic medication Effexor (antidepressant) which was required twice daily . The NARSUM also offered findings rendered by a conference of mental health providers, who reviewed the CI’s military and civilian provider treatment records, then concluded she suffered from a condition [MH] that precluded her from rendering any further useful military service.

The Compensation and Pension (C&P) Mental Disorder Exam, dated 28 January 2003, approximately 8 months after separation, was not signed and the physician was not identified. The examiner stated the CI’s speech was normal rate and rhythm. Her mood was upbeat, but she reported that she felt her depression returning. Affect was bright and sunny. Thought patterns were linear and goal-directed. She was not suicidal, homicidal or psychotic. The CI stated she was concerned that her depression was going to return and she would be irritable with her new son, which she wanted to avoid. The Axis I diagnosis was MDD secondary to a general medical condition. GAF score was 70.

The Board carefully reviewed all available evidence and directs attention to its rating recommendation. The Board noted the disparity between the NARSUM and C&P MH exams, which were equidistance (approximately 8 months) from the time of separation. The Board deliberated on the probative value of both exams. Based on the comprehensiveness, application of psychological tests and review by a conference of MH providers, the Board majority placed greater probative value on the MEB psychiatric NARSUM. The Board deliberated and concluded that the CI’s condition had improved after separation; however, the Board’s recommendation is based on the CI’s psychological status at the time of separation.

During the MEB psychiatric NARSUM, the CI was given two psychological tests that profiled her as psychologically maladjusted, occupationally impaired, with possible MH diagnoses ranging from schizoid to self-defeating traits. The examining psychiatrist diagnosed her with an Axis I MDD; severe, recurrent, without psychotic features with a GAF score of 50 (severe); while her military impairments were judged as severely impaired and civilian work capacity was judged as being moderately impaired. The NARSUM also showed that the CI’s MH condition required a third psychotropic medication in a continuing attempt to control her MH condition. Lastly, the NARSUM exam document ed a conference of MH providers, who reviewed the CI’s military and civilian provider treatment records, then concluded the “service member suffers from a condition [mental health] that precluded her from rendering any further useful Military service.”

After due deliberation, the Board determined that based on the evidence and IAW VASRD §4.130 at the time of separation, the most appropriate disability rating recommendation was 30%. The Board determined her chronic MH symptoms causing military and civilian work impairments could reasonably be projected at the time of separation and thereby exceeded the 10% rating criteria. The Board found it reasonable and justified that a 30% rating of occasional occupational and social impairment, with a decrease in work efficiency and intermittent inability to perform certain tasks could be applied at the time of separation. Considering all of the evidence, and mindful of VASRD §4.3 (reasonable doubt), the Board recommends by majority decision a disability rating of 30% for the unfitting MH condition.


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, the Board recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130. The single dissenting voter elected to submit the appended minority opinion. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:

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



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120718, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                                   
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
MINORITY OPINION: In this case the action officer dissented, and did not agree with the other two Board members. The dissenting member recommended no change in the PEB adjudication of the MDD condition.

The CI had an MH evaluation in September 2002 and another one in January 2004. After a thorough review of the record, it was clear that the CI’s condition improved during the period from September 2002 to January 2004. She separated from service in the middle of this 16-month period of time. Unfortunately, no comprehensive MH evaluation was performed at the time of separation, so the Board must use the best evidence available.

The dissenting member felt that, in September 2002, there were several factors contributing to the CI’s depressive symptoms. During the weeks and months leading up to her separation from service, some of these factors were alleviated. This would have contributed to her improvement. The dissenting member felt that at the time of separation, it was more likely than not that the CI was functioning well, and was not significantly impaired by MH symptoms.

Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the dissenting member concluded that there was insufficient cause to recommend a change in the PEB adjudication for the major depressive disorder condition.

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



MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
         COMMANDER, NAVY PERSONNEL COMMAND
        
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 17 Nov 14 ICO XXXXXXXXXXXXXXXXXX
(c) XXXXXXXXXXXXXXXXXX

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (c).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a. J XXXXXXXXXXXXXXXXXX , XXX XX XXXX , former USN : Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.
b. XXXXXXXXXXXXXXXXXX

3. Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.



          XXXXXXXXXXXXXXXXXX
         Assistant General Counsel
(Manpower & Reserve Affairs)

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