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AF | PDBR | CY2013 | PD-2013-01604
Original file (PD-2013-01604.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-01604
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20140723
SEPARATION DATE: 20040107


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (2W071/Munitions System Craftsman) medically separated for major depressive disorder (MDD). The mental health (MH) condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS). He was issued a permanent S4 profile and referred for a Medical Evaluation Board (MEB). The condition, characterized as “MDD, single episode” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. The MEB also identified and forwarded one other condition (severe personality disorder not otherwise specified (NOS)). The Informal PEB adjudicated “MDD” as unfitting, rated 0%, referencing Department of Defense Instruction (DoDI) 1332.39 and the Veterans Affairs Schedule for Rating Disabilities (VASRD). The severe personality disorder NOS w as determined to be C ategory III. The CI made no appeals, and was medically separated.


CI CONTENTION: “Still have knee problems, suffer from migraines. Right shoulder bricytis, on meds for anxiety/Depression, hearing loss and vision loss.”


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 knee, headache, hearing and vision loss conditions were not identified by the PEB, and thus are 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 20031203
 VA - (5 Mos Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Major Depressive Disorder 9434 0% Depressive Disorder 9434 10% 20040623
Personality Disorder NOS Category 3 No VA Entry
No Other Conditions in Scope
 Other x 8 20040623
Combined: 0%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 40810 ( most proximate to date of separation ).


ANALYSIS SUMMARY:

Major Depressive Disorder. The service treatment record (STR) contained few source of MH documents and most historical information was obtained by subsequent summary documents. After earlier years of treatment/counseling for substance abuse and marital discord, the CI was referred to Life Skills program where he received his first MH diagnosis of adjustment disorder in June 2003 (6 months prior to separation). At that time his Global Assessment of Functioning (GAF) was 70; connoting “mild” impairment. The STR noted no change in the CI GAF over the next 4 months of evaluations; records of documentation ending in late September 2003. The MEB psychiatric narrative summary (NARSUM) dated 24 October 2003 (7 months prior to separation), summarized the CI’s prior MH encounters as chronic depression secondary to long distance separation with both his fiancée as well as his two children who were in the custody of his ex-wife. The examiner noted minimal cooperation from the CI in an attempt to address any form of depressed symptoms and additionally reported the CI as stating, “The only things which seem to help are telephone calls to his family, and taking leave to visit them as often as possible.” The CI endorsed having a brief attention span, poor concentration, poor sleep quality, low energy, lack of motivation, and task completion delay. He further endorsed a high level of subjective distress, and a tendency to feel worse when he ruminates about missing his family. “The [CI’s] motivation to improve with treatment appears low, as he is motivated to be near his family in New York and appears to have a high level of commitment to the belief that being near his family is the only way to improve his mood and functioning.” The mental status examination revealed a depressed mood, restricted but appropriate affect, poor insight and fair judgment. There were no suicidal/homicidal ideations, plans, or intent. His GAF was approximately 55; connoting between “serious” and “moderate” impairment and the Axis I diagnosis was severe, single episode, MDD. His social/industrial and military impairment were described as “minimal” and “marked” respectively.

At the VA psychiatric Compensation and Pension examination performed on 09 July 2004 (6 months after separation), the CI reported a history of having problems with low mood, irritability, and insomnia consistently over the last 3 years. He denied past use of psychotropic medications or hospitalizations for psychiatric reasons. He endorsed unlimited abilities in performing activities of daily living. His mental status examination was detailed and revealed a dysphoric (feeling unwell or unhappy) but appropriate contextual affect and a dysthymic (mild, but chronic depression) mood. All other aspects of the examination were appropriate and or intact. His primary diagnosis was depressive disorder NOS. His GAF was 61, indicating “moderate” impairment.

The Board directs attention to its rating recommendation based on the above evidence. Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH conditions. Both the PEB and VA applied the clinically appropriate code 9434 (MDD) and arrived at different ratings (0% and 10% respectively) under VASRD §4.130. The service listed the unfitting condition as “none” for “social and industrial adaptability impairment”; thus rendering a 0% rating. The VA cited “mild” impairment symptoms supporting a 10% rating. The Board first considered if the definition of VARD §4.129 was met for the unfitting MH condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.” Board members agreed that although some contribution of service stressors to his MH condition were present, the overwhelming stressors stemmed from family discord, both in his first and second marriage by way of his children living distantly with his ex-spouse. Therefore, the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not adequately satisfied. The Board therefore will consider only the VASRD §4.130 impairment present at separation for a single rating recommendation. Members considered if there was evidence for a §4.130 rating higher than PEB’s 0% at time of separation. The NARSUM indicated that the CI was not on any medication and therefore that particular criterion in the 10% rating level is not applicable and the rating must be based upon the degree of industrial and social impairment. Although the PEB indicated “none” for the degree of social and industrial impairment, the NARSUM examiner specifically noted “minimal” for the same parameter. Board members agreed that the PEB incorrectly captured the MEB’s evaluated evidence and that “minimal” is synonymous with either “mild” or “transient” thus supporting the 10% level IAW 4.130. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the MDD 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. As discussed above, PEB reliance on DoDI 1332.39 for rating MDD 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 unanimously recommends a disability rating of 10%, 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, effective as of the date of his prior medical separation:

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


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130923, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record










                          
XXXXXXXXXXXXXX
President
Physical Disability Board of Review


SAF/MRB
Dear XXXXXXXXXXXXXX:
         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-01604.

         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 Affairs Schedule for Rating Disabilities. Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your 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 direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force. The office responsible for making the correction will inform you when your records have been changed.

                                                               Sincerely,






 XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachments:
1. Directive
2. Record of Proceedings

cc:
SAF/MRBR

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