RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXX 
BRANCH OF SERVICE:  NAVY 
CASE NUMBER:  PD1200753                                                                  SEPARATION DATE:  20021023 
BOARD DATE:  20130117 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  IC3/E-4  (IC3/Interior  Communications  Electrician 
Third  Class),  medically  separated  for  a  mental  health  condition.    She  did  not  respond 
adequately  to  treatment  and  was  unable  to  meet  the  requirements  of  her  rating  or  meet 
worldwide deployment standards.  She was placed on limited duty and underwent a Medical 
Evaluation  Board  (MEB).    The  CI  had  four  mental  health  conditions:  posttraumatic  stress 
disorder  (PTSD),  chronic,  delayed  onset;  major  depressive  disorder  (MDD),  single  episode, 
moderate severity without psychotic features; anxiety disorder, not otherwise specified (NOS), 
and  impulse  control  disorder  were  forwarded  to  the  Physical  Evaluation  Board  (PEB)  IAW 
SECNAVINST  1850.4E.    The  PEB  adjudicated  MDD,  single  episode,  moderate  severity  without 
psychotic  features,  rated  10%,  with  application  of  Department  of  Defense  Instruction  (DoDI) 
1332.39 and Veterans Affairs Schedule for Rating Disabilities (VASRD).  For the three remaining 
mental  health  conditions,  PTSD  was  determined  to  not  be  unfitting  Category  II  condition 
(contributing  to  the  unfitting  condition);  the  anxiety  and  impulse  control  disorders  were 
determined to be Category III conditions (not contributing to the unfitting condition).  The CI 
made no appeals, and was medically separated with a 10% disability rating.   
 
 
CI CONTENTION:  The CI is deceased from multidrug toxicity and the application is made on her 
behalf by her mother.  No specific contention was stated in this application.   
 
 
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 ratings 
for  unfitting  conditions  will  be  reviewed  in  all  cases.    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.   
 
 

 

VA (~5 Mos. Post-Separation) – All Effective Date 20021024 
Condition 

Rating 

Code 

Exam 

Rating 
10% 

PTSD  with  Major  Depression 
Disorder  and  Panic  Disorder 
with Agoraphobia (Also Claimed 
as Impulse Control Disorder) 

9499-9411 

50% 

20030411 

the 

and 

Arachnoid 

Cyst 
Prominent 
Right 
Overlying 
Frontoparietal 
Small 
Arachnoid  Cyst  on  the  Coronal 
Sequence 
Left 
Cyst/Polyp 
0% X # / Not Service-Connected x # 
Combined:  80% 

Retention 

Maxillary 

8099-8003 

60% 

20030411 

6599-6513 

10% 

 
 

RATING COMPARISON:   
 

chronic  delayed 

Service PEB – Dated 20020826 
Condition 
Code 
Major Depressive Disorder  9434 
PTSD, 
onset 
Impulse  Control  Disorder, 
NOS 
Anxiety Disorder, NOS 

Not Unfitting 
Category 2 
Not Unfitting 
Category 3 
Not Unfitting 
Category 3 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

 
 
ANALYSIS SUMMARY:  The PEB rating, as described above, was derived from DoDI 1332.39 and 
preceded  the  promulgation  of  the  National  Defense  Authorization  Act  2008  mandate  for 
Department of Defense (DoD) adherence to the VASRD §4.129.  A salient question before the 
Board  is  whether  the  CI’s  mental  health  condition  meets  the  §4.129  definition  of  “a  mental 
disorder that develops in service as a result of a highly stressful event [that] is severe enough to 
bring about the veteran’s release from active military service.”  Should the Board decide that 
§4.129  is  applicable  in  this  case,  then,  IAW  DoDI  6040.44  and  DoD  guidance  the  Board  is 
obligated to recommend a minimum 50% §4.129 rating for a retroactive 6 month period on the 
Temporary Disability Retired List.  Linked with this decision is the Board’s assessment regarding 
the appropriateness of the PEB’s determination that PTSD was not, itself, unfitting.  The Board’s 
threshold for countering Disability Evaluation System fitness determinations is higher than the 
VASRD  §4.3  (Resolution  of  reasonable  doubt)  standard  used  for  its  rating  recommendations, 
but  remains  adherent  to  the  DoDI  6040.44  “fair  and  equitable”  standard.    In  drawing  its 
conclusions  regarding  these  aspects  of  this  case,  the  Board  considered  the  evidence  listed 
below. 
 
Mental Health Condition.  The MEB narrative summary (NARSUM) was written 4 months prior 
to separation.  The severity of the CI’s overall psychiatric conditions at the time could best be 
described as moderate.  The CI first presented to outpatient psychiatry in March of 2001 for a 
mental  health  evaluation  whereupon  she  was  diagnosed  with  the  above  four  referenced 
psychiatric disorders.  She reported a history of childhood molestation with classic symptoms of 
PTSD.    After  two  limited  duty,  outpatient  counseling,  and  multiple  medications  to  include: 
Temazepam (antianxiety) 30 mg at night for sleep, sertraline (antidepressant) 300 mg per day 
which exceeded the recommended dosage for depression, and Bupropion SR (antidepressant) 
200 mg twice daily to augment the sertraline, she continued to have persistent symptoms.  The 
non-medical  assessment  (NMA),  4  months  prior  to  separation,  documented  that  the  CI  was 
capable of performing her assigned duties, capable of participating in the Navy-wide physical 
fitness program, however, was not able to perform her Rating duties as a shipboard interior 
communications electrician.   
 
At the time of her MEB, with regards to her PTSD symptoms; she continued to have intrusive 
daytime recollections of her childhood molestation as well as nightmares, persistent insomnia, 
typically sleeping only 3 to 4 hours per night; these symptoms worsened in March 2002 due to 
an  extensive  discussion  with  her  sister,  who  was  also  molested.    With  regards  to  her  MDD 
symptoms;  she  continued  to  have  persistent  depressed  feelings  which  had  diminished 

   2                                                           PD1200753 
 

life  span  with 

somewhat compared to when she began treatment, described as a "seven" on a scale of "one 
to ten" with "ten" representing severe depression, and had increased symptoms with holiday 
stress  and  after  having  some  conflicts  with  her  supervisor,  persistent  irritability  and  fatigue.  
She had not been hospitalized throughout her treatment.  The CI was in a stable marriage for 3 
years, had a 2 year old son and denied current legal, alcohol or substance abuse problems.  The 
mental  status  exam  (MSE)  documented  mild  psychomotor  retardation  and  a  dysphoric, 
fatigued, and blunted affect, but appropriate.  The exam was otherwise normal without suicidal 
or  homicidal  ideations  or  signs  of  psychosis.    The  examiner  diagnosed  PTSD,  considered 
disabling,  and  with  DoDI  1332.39  defined  ‘moderate’  impairment  for  social  and  industrial 
adaptability.    The  examiner  also  diagnosed  MDD,  single  episode,  moderate  severity,  and 
without  psychotic  features,  considered  disabling,  and  with  DoDI  1332.39  defined  ‘severe’ 
impairment for social and industrial adaptability.  The examiner additionally diagnosed anxiety 
disorder, not considered disabling and impulse control disorder, service-aggravated, considered 
disabling.  The examiner opined the total degree of civilian performance impairment from all 
psychiatric sources was deemed severe and assigned a Global Assessment of Functioning (GAF) 
of 51 connoting moderate symptoms.  At the time of the VA Compensation and Pension (C&P) 
exams,  5  months  after  separation,  she  additionally  reported  being  stressed  about  being 
potentially  deployed  and  leaving  her  young  son  when  her  mental  health  condition  surfaced.  
She reported additional symptoms of obsessional thoughts, difficulty getting close to people, 
avoiding anything that reminds her of her trauma.  Additionally, she believed she had to live out 
her  full 
irritability,  hypervigilance,  exaggerated  startle  response,  had 
concentration  and  memory  problems,  insomnia,  helplessness,  and  appetite  changes.    The  CI 
had not been hospitalized, was taking only Zoloft due to her recent delivery of her 3-week old 
daughter,  had  remained  married,  and  still  cared  for  her  2-1/2  –year-old  son.    She  was 
unemployed, was out of the Navy, and had hopes to go back to college.  On MSE she had a 
restricted  affect  and  described  her  mood  as  somewhat  down,  with  fair  to  good  insight  and 
judgment.  The exam was otherwise unremarkable without suicidal or homicidal ideations.  The 
examiner confirmed the diagnoses of PTSD and depression, and assigned a GAF of 55 connoting 
moderate  symptoms.    The  examiner  further  opined  the  GAF  was  for  the  above  two  Axis  I 
diagnoses and could not be divided up due to overlapping nature of these disorders and further 
opined  impulse  control  disorder  and  anxiety  disorder  were  umbrellaed  under  the  PTSD  and 
panic disorder symptoms. 
 
The  Board  directs  its  attention  to  the  question  of  §4.129  applicability,  the  separate  fitness 
determinations,  and  it  rating  recommendations  based  on  the  evidence  just  described.    The 
Board considered that the MEB and VA psychiatrists made an Axis I diagnosis of PTSD, implying 
that they believed that Criterion A stressors were present from a traumatic childhood event, 
not a combat/service event.  The Board did surmise that the CI’s MOS duty impairment was 
accounted for by symptoms typical of MDD and additionally by symptoms typical of PTSD.  The 
Board  concludes  therefore  that  the  PEB’s  fitness  determinations  for  MDD  was  acceptable, 
however  the  Board  cannot find  enough  strength  in the  PEB  position to  overcome the  sound 
arguments  favoring  the  CI’s  position  regarding  the  PTSD  fitness  adjudication.    The  Board, 
therefore,  recommends  that  it  be  rated  as  an  additionally  unfitting  condition.    Regarding  its 
recommendation in regard to §4.129 applicability, the Board must note that the VA elected not 
to apply it.  The Board also points to two collateral issues which mitigate any practical import of 
applying §4.129 to this case.  One such issue is that, although the fitness implications of each 
psychiatric disorder can be differentiated, the §4.130 ratable impairment from MDD and PTSD 
cannot be separated without undue speculation; nor does the VASRD allow for separate ratings 
of  co-existent  psychiatric  conditions.    The  Board’s  rating  recommendation  will  therefore 
encompass a de facto rating for PTSD regardless of fitness adjudication or §4.129 application.  
The additional issue is that the Board’s permanent rating recommendation, were §4.129 to be 
followed,  would  rest  on  the  C&P  evaluation  which  is  already  significantly  probative  to  the 
Board’s assessment of a fair permanent rating recommendation as the examination is almost 6 
months after separation and reflects the stress of transition to civilian life, which is a core intent 

   3                                                           PD1200753 
 

of §4.129.  The Board therefore sees neither firm support for, nor significant practical value to, 
application of §4.129 in the circumstances of this case. 
 
Turning  attention  to  the  permanent  rating  recommendation,  all  members  agreed  that  the 
§4.130  threshold  for  a  10%  rating  was  easily  exceeded  and  that  the  70%  threshold  was  not 
approached.  The Board’s deliberations were centered therefore on arguments for a 30% vs. 
50% permanent rating recommendation.  The Board agreed that the MEB psychiatric evaluation 
could justify a §4.130 rating of 50% (occupational and social impairment with reduced reliability 
and  productivity)  based  on  the  distinct  evidence  for  declining  duty  performance  due  to  the 
pervasive symptoms of depression and PTSD.  There is, however, also an argument for a 30% 
rating  (occupational  and  social  impairment  with  occasional  decrease  in  work  efficiency  and 
intermittent periods of inability to perform occupational tasks), considering the CI’s generally 
intact interpersonal functioning and PTSD and MDD symptoms not controlled by medications, 
the VA examiner’s assignment of a GAF similar to that on separation and the NMA statement 
that  she  was  functioning  but  not  eligible  for  shipboard  duty.    The  Board  could  not  weigh 
employment  issues  as  she  was  on  maternity  leave,  but  did  weigh  her  hopes  to  go  back  to 
college  as  a  sign  of  improvement  in  her  depression.    After  due  deliberation,  and  in 
consideration of the totality of evidence and VASRD §4.3, the Board recommends 30% as the 
fair permanent separation rating for the mental health 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  mental  health  condition,  the  Board  unanimously 
recommends  that  PTSD  be  added  as  an  additionally  unfitting  condition  for  separation  rating 
and unanimously recommends a disability rating of 30% for the mental health condition, coded 
9411-9434  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:   
 

VASRD CODE  RATING 
9411-9434 
COMBINED 

30% 
30% 

XXXXXXXXXXXXXXXXXXX 
Director 
Physical Disability Board of Review 

   4                                                           PD1200753 
 

UNFITTING CONDITION 
PTSD with Major Depression Disorder 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120612, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 

 

 

 COMMANDER, NAVY PERSONNEL COMMAND 

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS 
 
 
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 
 
Ref:   (a) DoDI 6040.44 
          (b) PDBR ltr dtd 29 Jan 13 ICO XX 
          (c) PDBR ltr dtd 15 Jan 13 ICO XX 
          (d) PDBR ltr dtd 22 Jan 13 ICO XX 
                                         
1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of 
Review set forth in references (b) through (d). 
 
2.  The official records of the following individuals are to be corrected to reflect the stated 
disposition: 
 
     a.  XXXXXXX former USN:  Disability retirement with a final disability rating of 30 percent 
with retroactive placement on the Permanent Disability Retired List effective 23 October 2002. 
 
     b.  XXXXXXXXX former USMC:  Disability retirement with a final disability rating of 30 
percent with retroactive placement on the Permanent Disability Retired List effective 31 January 
2002. 
 
     c.  XXXXXXXXX former USMC:  Disability separation with a final disability rating of 20 
percent (increased from 10 percent) with entitlement to disability severance pay effective 30 
September 2002. 
 
3.  Please ensure all necessary actions are taken, included the recoupment of disability severance 
pay if warranted, to implement these decisions and that subject members are notified once those 
actions are completed. 
 
 
 
 
 
 
 

  XXXXXXXXXXX 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

   5                                                           PD1200753