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AF | PDBR | CY2013 | PD-2013-02068

Original file (PD-2013-02068.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX CASE : PD -20 13 - 0 2068
BRANCH OF SERVICE: Army BOARD DATE: 201 4 0731

Separation Date: 20060129

SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was a R eserv e 0-3 (Engineering Officer) medically separated for major depressive disorder (MDD) . The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent S4 profile and referred for a Medical Evaluation Board (MEB). The major depressive disorder condition characterized as “ major depressive disorder, recurrent, severe without psychotic feature” and “panic disorder without agoraphobia as manifested by discrete periods of intense fear” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions w ere submitted by the MEB. The I nformal PEB adjudicated “ major depressive disorder , recurrent, severe without psychotic features in partial remission, associated with a panic disorder, without agoraphobia ” as unfitting, rated at 10% , with likely application of the Veteran s Affairs Schedule for Rating Disabilities (VASRD). The CI appealed to the Formal PEB (FPEB) which affirmed the PEB finding and rating.

CI CONTENTION : “Although the Army Rating for the disabling condition was only 10%, the VA determined service connection for posttraumatic stress disorder and is evaluated together with my service connected major depressive disorder and panic disorder with an evaluation of 50%. The disabling conditions of Major Depression, Anxiety, and PTDC continue to cause problems with my family and my job.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON :

invalid font number 31502

Service FPEB – Dated 20050906	VA - (7 Mos. Post-Separation)
Condition	Code	Rating	Condition	Code	Rating	Exam
MDD	9434	10%	MDD with Panic Disorder and Alcohol Abuse*	9434	50%	20060802
No Other Items in Scope	Other x6 (Not in Scope)
Combined: 10%	Combined: 70%

Derived from VA Rating Decision (VARD) dated 20060926 (most proxi mate to date of separation )
* VARD 20080415 changed condition to MDD with Panic Disorder, PTSD and alcohol abuse and continued the rating of 50% effective 20060130.
invalid font number 31502

ANALYSIS SUMMARY : The Board notes the current VA ratings listed by the CI for all of his 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 the VA .

MDD Condition . The CI reported that he had depressive and panic symptoms since age 20. He discontinued his anti-depressant medication (Zoloft) prior to attending ranger school in 1998 and successfully finished that training . He had an exacerbation of his depression and anxiety in June 1998 and was seen in the ER for suicidal ideation. He was admitted to the inpatient psychiatry service at Fort Bragg and restarted on Zoloft ; remained on Zoloft from June 1998 through November 2001. A n MEB was pursued yet the CI did well in outpatient psychotherapy , was compliant with medication and successfully rebutted the MEB to stay on active duty. During the time period of November 2001 through March 2002, the CI ’s anti-depressant medication was change from Zoloft to Venlafaxine , which he remained on through June 2002 . However, during that same time period the psychiatris t attempted to taper the CI off the Venlafaxine; which was unsuccessful due to a return of significant anxiety symptoms. From July 2002 through to October 2002, the CI was placed on the anti-depressant Wellbutrin, but in December 2002, he was seen by outpatien t psychiatry service for worsening of depression , short - term memory deficits, decreased energy, significant nightmares and increased anxiety. He was then given Celexa , which he tolerat ed well and had a good effect and was able to deploy from April 2003 through to July 2004 . Later that year, in October 2004, the CI took command of an Engineer Company . In January 2005, the CI noti ced worsening of his symptoms . The MEB narrative summary (NARSUM) exam ( approximately 1 1 months prior to separation ) documented that the mental status exam was normal and that he was compliant with his anti-depressant medication with no active alcohol abuse. The psychiatri st diagnosed recurrent MDD without psychotic features with marked military duty impairment and marked social / industrial adaptability impairment. The examiner documented that although this disorder apparently existed prior to service, this certainly was exacerbated by military service. Additionally, the examiner commented that the previous diagnosis of panic disorder was not warranted as he did not meet the DSM IV criteria for that illness and his panic experiences were entirely an accompaniment of his depression. The Global Assessment of Functioning (GAF) was 85 , no more than slight impairment in social, occu pational, or school functioning ( the best GAF for the year ) . The psychiatric addendum exam (completed approximately 10 months prior to separation ) , documented that the CI had been recently hospitalized on 31 March 2005 through to 5 April 2005 , for a n apparent suicide attempt and fu rther exacerbation of a n underlying major depressive disorder with panic disorder without agoraphobia . During this hospitalization, the CI was started on Klonopin and diagnosed with recurrent severe MDD ( without psychotic features as manifested by depressed mood ) and panic disorder without agoraphobia The GAF was 50 , serious impairment in social, occupational, or school functioning.
T he commander’s statement summarized the throughout the 20 months that the commander observed the CI, the psychiatric hospitalizations , ongoing psychiatric treatment and the CI ’s illness was not revealed to him. The commander goes on to recommended that the CI be re - assigned into a career path that would include a stable environment associated with lower stress leve ls and believed that the he would have the capacity to serve in the Army. The CI’s treating psycholog ist sent a memorandum to the PEB which documented that the CI had benefitted from psychotherapy and that taking psychotropic medications had lessened the depression and anxiety conditions . The psychologist did note that due to the CI’s significant psychiatric history , he would need to continue mental health services in the future. He further opined that the CI fitness for continued military service depended on his future accessibility to a mental health services. A second commander’s statement on the CI’s performance for the time period of 25 April 2005 to 8 August 2005 stated that the CI displa yed a sharp, professional image, maintained a positive, proactive attitude and that he did not exhibit any signs of emotional impairment but rather consistently performed both effectively and efficiently. After separation on 29 January 2006, the CI exhibited extreme difficulty in acclimating back to civilian life. The CI was seen by a behavioral health social worker who noted that some of his responses during an assessment process potentially aligned with the diagnosis of posttraumatic stress disorder (PTSD) and referred the CI to PTSD clinic. The psychiatrist in a brief note documented that the CI endorsed symptoms of heavy alcohol use, wallowed in indecision, anger and depression but no suicidal intentions. The psychiatrist continued the diagnosis of PTSD , MDD and alcohol abuse . Notes i n the STR from February 2006 through to July 2007 describe the CI as endorsing continued symptoms of depression . He would self-isolate f r o m his friends and had marital difficulties with his wife. He would lapse into periods of heavy drinking although he recognized this as a maladaptive way of coping with his situation. The CI was seen monthly by a psychiatrist who documented that the CI continued to be affected by negative effects of PTSD, suicidal ideations, depression, anxiety, infrequent flashbacks and intrusive memories of war, poor sleeping and hyper startle .

The VA Compensation a nd Pension (C&P) exam ( approximately 6 months after separation ) documented that the CI experienced frequent mortar and rocket attacks during his time in theater; reported that a rocket fell within 100 y ards of him . The psychologist opined that these experiences and other events met the DSM-IV criteria for traumatic stressors leading to PTSD. The Army diagnosed MDD ( recurrent, without psychotic features ) and panic disorder without agoraphobia , based on a suicide attempt with significant exacerbation of depression and anxiety after redeployment from theater . The diagnosis of PTSD was not rendered by the Army psychiatrists. The CI reported depressive symptoms most days . The mental status exam showed a highly dysphoric mood, constricted af fect, passive suicidal ideation and occasional use of alcohol. The examiner diagnosed recurrent MDD without psychotic features, PTSD, chronic panic disorder without agoraphobia , in partial remission, alcohol abuse and a GAF of 49 , any serious impairment in social, occupational, or school functioning. Throughout 2007, the CI continued to vacillate between periods of depression, anxiety, suicidal ideation and alcohol abuse to periods of sobriety with depressive symptoms in remission. A second VA C&P exam (performed approximately 18 months post separation ) documented an ER visit for a panic attack and continued bimonthly individual counselling sessions at the Vet erans Medical Center. He was actively drinking and had occasional blackouts; reported m issing 5 days of work due to depression and lack of motivation; self-isolation and strained family / marital relationships. The psychologist diagnosed recurrent MDD without psychotic features, PTSD, chronic panic disorder without agoraphobia, in partial remission, alcohol abuse and a GAF of 44 .

The Board direct ed attenti on to its rating recommendation based on the above evidence . The F PEB coded the MDD condition as 9434 and rated at 10%. The VA coded the MDD with panic disorder and alcohol abuse (claimed as acquired psychiatric disorder) condition as 9434 and rated at 5 0%. The VA changed the condition to MDD with panic disorder, PTSD and alcohol abuse and continued the rating of 50% effective 30 January 2006.
Protracted Board deliberations centered on the discrepancy between the minimal occupational impairment/mental health symptoms documented by the pre-separation evidence and the significant mental health symptoms documented in the post-separation evidence. The pre-separation evidence contained a NARSUM that documented a GAF of 85 and that he met retention standards. The psychological statement most proximate to separation documented a GAF of 75 and stated if the CI had mental health services available and a minimally stressful assignment he could remain on active duty. Both commanders’ statement documented that the CI was performing well and should be allowed to remain on active duty. A ll officer evaluation reports present for review , including one within 10 month s of separation, documented that the CI was either “Best” or “Fully Qualified.” In contrast, the post-separation evidence documents that the CI was working in a manager trainee position at K -M art in spite of significant mental health symptoms. It was also documented that he had difficulty adjusting to civilian life and was abusing alcohol. His post-separation GAFs were 49 and 44. Board discussions considered the VA diagnosis of PTSD and Board members agreed that the CI did not meet the Diagnostic and Statistical Manual for Mental Disorders IV TR diagnostic criteria for PTSD. The Board discussed the likelihood that prior to separation, the CI minimized his symptoms in an attempt to remain in the servic e as the evidence clearly supports that was his intention. After separation, the CI’s mental health condition either worsened or he was more forthright with the VA providers about his symptoms, in either case, the VA is charged with post - separation medical issues as discussed in the analysis summary above. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication 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 M ajor D epressive D isorder condition and IAW VASRD §4. 30 , the Board , by majority vote, recommends no change in the PEB adjudication. The single voter for dissent did not elect to submit a minority opinion. There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION : The Board, therefore, recommends that there be no re - characterization of the CI’s disability and separation determination .

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20 131030 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXX

President

DoD Physical Disability Board of Review

SAMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX AR20150008340 (PD201302068)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

invalid font number 31502 Encl                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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AF | PDBR | CY2013 | PD-2013-02068

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