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AF | PDBR | CY2012 | PD2012 01874
Original file (PD2012 01874.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX         CASE: PD1201874
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20130523
SEPARATION DATE: 20060317


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (7S071/Office of Special Investigation last 2 years on Active Duty and 2E231, Communications, Network switching and Crypto Systems) medically separated for a mental health condition (major depressive disorder [MDD]). She first sought treatment for her anxiety and depression in August 2005, but could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty. She was issued a temporary S3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded major depression to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB (IPEP) adjudicated MDD as unfitting, rated 30%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). However, the IPEB stated the condition existed prior to service (EPTS) and deducted 20%. The CI made no appeals, and was medically separated.


CI CONTENTION: “On active duty, I was diagnosed with major depression. The doctor stated it was a pre-existing condition but in my therapy sessions I discussed several forms of trauma in my position as an AFOSI Agent. The VA has now acknowledged that I do have PTSD (posttraumatic stress disorder) and that it is from my service.”
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 condition is addressed below. The requested posttraumatic stress disorder (PTSD) condition was not identified by the PEB, and thus is not 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 Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20060201 VA – (~1 Mos. Pre-Separation)
Condition Code Rating Condition Code Rating Exam
Major Depressive D/O 9434 10% Major Depression 9434 30%* 20060426
No Additional MEB/PEB Entries Other x 5 20060426
Combined: 10% Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 60824 .
*Rating increased to 50% with C&P exam 20070918 then 70% with VA evidence from 2008 to 2012.


ANALYSIS SUMMARY: The Board notes the current VA ratings listed by the CI for her service-connected conditions, but must emphasize that its recommendations are premised on severity at the time of separation. The VA ratings which it considers in that regard are those rendered most proximate to separation. The Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to Department of Veterans Affairs.

Major Depressive Disorder. The Board first addressed if the tenants of §4.129 (mental disorders due to traumatic stress) were applicable. The Board considered the multitude of stressors elaborated in the treatment record including marital problems, parenting issues, miscarriages, interpersonal difficulties at work, witnessing child pornography and exposure to dead bodies. The Board determined that there was no “highly stressful event” for which provisions of §4.129 would apply, and therefore concludes that its application is not appropriate to this case. Consequently, the Board need not apply a 50% minimum constructive Temporary Disability Retired List rating in this case. The enlistment medical exam (1998) indicated no history of depression or anxiety. Three post-deployment health assessments from April 2001 to November 2002 (Kuwait twice and Germany) indicated no deployment traumatic exposures. In November 2005, she was admitted to a civilian partial hospital program (PHP) following a reportedly unintentional overdose. By this time, she had been on psychotropic medication for 3 months. Current stressors included marital problems, two miscarriages, her involvement as an investigator in cases of rape and child pornography, and a pending deployment. Although one examiner reported no past psychiatric history, the CI informed another examiner that she had a diagnosis of an eating disorder in high school. 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 of Functioning (GAF) of 65 (some mild symptoms or impairment). At the narrative summary NARSUM exam on 24 January 2006 (2 months prior to separation) the CI reported that she had “struggled with depressive episodes since her teen years,” but denied past psychiatric diagnosis or treatment. The primary stressors were considered to be occupational problems, marital difficulties and multiple miscarriages. Nightmares were noted but were not specifically related to traumatic experiences. She reported an auditory hallucination (heard the voice of a suicide victim). She continued the same three-drug psychotropic regimen. The MSE was transcribed from an evaluation performed 2 months previously, and noted a sad mood, no abnormality of thought process or memory, and no evidence of psychosis or dangerousness. The assessment was MDD, recurrent, severe with psychotic features. The onset of depression was stated to be at age 17. The assigned GAF was 53 (moderate symptoms or impairment). The CI was re-admitted to the PHP on 31 January 2006 for depression without suicidal thoughts. Stressors included letters of counseling at work for being late, a negative work environment, adjusting to a new parenting role with a stepson and marital conflict. The admission MSE was normal except for depressed mood. The final PHP note (27 February 2006) described no depression and a low risk of dangerousness. At a civilian mental health evaluation on 20 March 2006 (3 days after separation), the CI reported that medications had “not helped her any so far” and that when she felt depressed she coped by going shopping. Stressors during the prior year reportedly included her husband’s deployment, the CI’s involvement in investigating a suicide, exposure to dead bodies and perceived unfair treatment by work colleagues. The CI’s condition was assessed as “depression, post-traumatic stress disorder and borderline personality features.” A follow-up evaluation by a civilian psychiatrist on 24 April 2006 (approximately a month after separation) reported panic attacks a few days a week and frequent crying spells in the context of discontinuing a medication. The MSE was normal except for depressed mood, and the GAF was 50 (serious symptoms or impairment). Her medication regimen was revised. At a VA Compensation and Pension (C&P) exam on 26 April 2006, the CI complained of crying, poor motivation, anxiety, mild insomnia, and fatigue. She was taking a four-drug regimen, and the effectiveness of treatment was considered “good.” The exam noted depressed mood, constricted affect, normal thought process, “paranoid ideation,” and occasional suicidal thoughts. Appearance, orientation, concentration and judgment were normal. Panic attacks reportedly occurred weekly. There were no problems with activities of daily living. The diagnosis was major depression, moderate, and a GAF of 65 was assigned. Occupational and social impairment were assessed as mild or transient. At a general medical C&P exam on 3 May 2006 (6 weeks after separation), the examiner’s observation of the CI was: “Laughing…pleasant, talkative, offered information easily on her daily activities, very neat and well groomed, makeup and highlights her hair.” At a C&P PTSD exam in September 2007 (18 months after separation) the CI reported exposure to “many dead bodies” in her investigator position and said, “…I have a lot of nightmares. Sometimes not directly about what I saw but about other things. Terrorists after me or attacked by a tiger.” The psychologist reviewed the pre-enlistment episode of partner abuse, and the CI reported that she had felt “sad a lot.” She also alleged that she was “groped” by another airman in 1999, who was subsequently required to apologize to her. The psychologist noted a history, following high school, of independent living, continuous employment, as well as 2 years of fulltime college attendance, until the time of her enlistment. At the time of the exam, she was occupied with housekeeping and parenting. The MSE was normal except for depressed mood. The psychologist opined, “The veteran does not currently demonstrate a full constellation of symptoms consistent with a post-traumatic stress disorder.” The Axis I diagnoses: anxiety disorder not otherwise specified; MDD, recurrent, mild-moderate without psychotic features; Axis II: no diagnosis; and, a GAF of 55.

The Board directs attention to its rating recommendation based on the above evidence. The PEB assigned a current rating of 30% and deducted 20% for “the longstanding EPTS diagnosis of Depression.” The VA assigned a 30% rating, citing a lack of findings on the enlistment exam as a basis for imposing no EPTS deduction. In deliberating a rating recommendation, the Board considered that several threshold symptoms for the 30% rating were present, but that GAF scores assigned by different providers were somewhat inconsistent. The Board was also challenged by other inconsistencies. For example, the CI denied any history of abuse at the NARSUM exam, but other examiners reported sexual abuse and stalking prior to entry in the service; panic attacks reportedly occurred multiple times per week by one examiner, yet 2 days later another examiner reports them occurring weekly; and a very positive mental state described by the VA general C&P examiner 6 weeks after separation seemed incongruent with previous exams. The Board ultimately agreed with the PEB and the VA however that the §4.130 criteria for the 30% rating (occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks) most accurately described the condition at the time of separation. Next, the Board deliberated factors for a deduction for disability which may have existed at the time of entrance into active service. Although the CI reported episodic depression since adolescence and alleged relational abuse in early adulthood, there was no documentation of past psychiatric diagnosis or treatment, and no history of occupational impairment, at the time of enlistment. The Board members unanimously agreed that there was no ascertainable degree of disability existing at the time of entrance into active service; and, therefore, no rating deduction for EPTS factors should be recommended. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the major depressive disorder 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 MDD condition, the Board unanimously recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130. 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 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 20121102, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record

         XXXXXXXXXX, DAF
         Director of Operations
         Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews MD 20762
Dear X XXXXXXXXXX :
         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2012-01874.
         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 not appropriate under the guidelines of the Veterans Administration Schedule for Rating Disabilities. Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.
         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly. The office responsible for making the correction will inform you when your records have been changed.
         As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP). Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election. If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

                                                               Sincerely,

XXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN

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