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AF | PDBR | CY2013 | PD-2013-02572

Original file (PD-2013-02572.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX CASE: PD-2013-02572
BRANCH OF SERVICE: Army BOARD DATE: 20150729

SEPARATION DATE: 20050725

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Heavy Equipment Operator) medically separated for mental health conditions. These conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB). Depression was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB (IPEB) adjudicated mood disorder not otherwise specified (NOS) with elements of posttraumatic stress disorder (PTSD) as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). An Administrative PEB was conducted that did not change the CI’s disposition or rating. The CI made no appeals and was medically separated.

CI CONTENTION: The applicant makes no specific contention in his application. His complete submission is at Exhibit A.

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 condition 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 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 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 :

Service Admin IPEB – Dated 20050707	VA - (**~4 Mos. Post-Separation)
Condition	Code	Rating	Condition	Code	Rating	Exam
Mood Disorder NOS with elements of PTSD*	9435	10%	Major Depressive Disorder (MDD) with PTSD	9434-9411	30%	20051116
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1
Combined: 10%	Combined: 30%

*MEB forwarded “ depression ” but the PEB adjudicated “mood disorder NOS with elements of PTSD ”
* *Derived from VA Rating Decision (VARD) dated 200 51206 (most p roximate to date of separation {DOS} )

ANALYSIS SUMMARY:

Mood Disorder Not Otherwise Specified (NOS) with Elements of Posttraumatic Stress Disorder (PTSD). The MEB narrative summary (NARSUM) noted the CI’s depressive symptoms emerged after his wife expressed interest in pursuing a separation. The CI had just returned from his January 2005 Iraq deployment where he had been for a year. He was upset that he was having issues with his wife, and sought counseling on post; however, he remained distraught which led to thoughts of suicide. His first encounter with psychiatry occurred as the result of suicidal ideation with the plan of shooting himself to death. The CI reportedly wrote letters to his wife, children, and to the authorities. On 12 March 2005, while his friends were present, he loaded his gun, attempted to point it to his head and pull the trigger on 2 or 3 different occasions, but could not pull the trigger. The gun was taken away and he was transferred to the emergency room and subsequently admitted to the psychiatry unit. During hospitalization, the CI reported several weeks of worsening symptoms consisting of depressed mood, poor sleep, and rumination, loss of interest in pleasurable activities, decreased concentration and suicidal ideation. He also noted that while in Iraq, he was subjected to mortar fire almost daily, his unit was ambushed on several occasions, and he lost members of his unit during combat. He had experienced loss of sleep and appetite one month before his return from Iraq, and noted symptoms of PTSD (nightmares, avoidance behavior, hypervigilance, emotional detachment). It was noted that his score on the PCL-M test and on the Mississippi Scale for combat related PTSD were not significantly elevated. The CI reported he began drinking heavily to cope with feelings of loneliness and sadness. The CI continued to express suicidal thoughts during his hospitalization, and had no pre-military history of psychiatric treatment or concerns. He was discharged to outpatient care 10 days post admission, and reportedly continued to report symptoms of depression. The CI was treated with antidepressant medications and reported his sleep improved, but his appetite remained decreased and his anxiety level increased related to the demise of his marriage.

The MEB NARSUM dated 11 May 2005 documented a mental status examination that appeared to have occurred on 20 April 2005. The examiner noted a constricted affect, dysphoric mood, and absence of psychosis, suicidal and homicidal thoughts. Judgment was not impaired. Diagnoses recorded were depressive disorder NOS; PTSD, mild to moderate, related to combat experienced in Iraq; and partner relationship problems. A Global Assessment of Functioning (GAF) score of 50 (borderline moderate-severe) was assessed. On 25 May 2005, 2 months prior to separation, an MEB psychiatry addendum documented the CI was living in the barracks, was still married, and spent his leisure time going to bars, having barbeques, and watching television. He consumed alcohol on a social basis, was compliant with his mental health treatment (psychotropic medications and talk therapy), but continued to have depressive symptoms and “uneasy thoughts” when reminded of his tour of duty in Iraq. His S3 profile restricted him from using firearms, and he noted that he felt the restriction was appropriate. The examiner deferred the mental status exam and referred the reader to the April 2005 exam noted above. Prognosis was documented as good as long as he continued in treatment, and the diagnoses of depression NOS and PTSD, mild to moderate were recorded. The commander’s statement acknowledged there had been emotional struggles during deployment; however, the CI had continued to “positively affect mission completion.” The commander wrote, “After re-deployment, [CI] personal life as well as his mental and emotional stability started to greatly affect his ability to be a Soldier and a leader.” It was noted that the CI’s martial problems began during his deployment and worsened towards the end of deployment, which caused him to seek help from his platoon leader and the battalion chaplain.

The VA Compensation and Pension (C&P) exam, approximately 4 months after separation, documented that the CI was separated from his wife and was living with his girlfriend of one year. He had been working full-time for 2 months at an excavating company. The examiner noted that the CI offered no particular complaint but that he was asked to evaluate the CI for PTSD and depression. The CI noted that he was not taking any psychotropic medications. The mental status exam documented predominately restricted affect, absence of suicidal thoughts, and no evidence of psychosis, impairment in cognition, or memory or judgment. The examiner recorded the diagnoses of MDD, mild and PTSD, mild. Axis II diagnosis was deferred; and the examiner recorded a GAF of 61-70 for PTSD symptoms (mild), and 55-60 (moderate for “overall GAF.” The examiner opined that the CI’s “dysfunction” is related to his depression and concerns about his future and past relationship, and opined that the CI’s PTSD symptoms would resolve once his depression is treated and resolves, “Provided he (CI) is willing to participate and really wants to get better.”

The Board directed attention to its rating recommendation based on the above evidence. The service rated his “mood disorder NOS, with elements of PTSD not separately unfitting,” coded 9435 (mood disorder NOS), and rated 10% for mild, and moderate improvement after treatment initiation. The VA coded his condition of MDD with PTSD under the analogous code of 9434-9411 and assigned a rating of 30%.

First, the Board noted there was no specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress. The Board agreed the provisions of §4.129 were not applicable. The Board noted that PEB’s determination that PTSD was not separately unfitting, and the condition of PTSD was not recorded in the MEB. The Board agreed the diagnosed mood disorder NOS (code 9435) best fit the CI’s ratable illness under §4.130 since the service treatment records reflect treatment was focused on mood condition and not PTSD. The Board opined both the NARSUM and C&P exams were proximate to separation and had equivalent probative value for rating. The Board proceeded to rate under §4.130 and compared the NARSUM opinion of the CI’s employability and work function, the C&P examiner’s opinion and the commander’s statement of duty performance. Deliberations focused on the 30% versus 10% rating levels. The 30% rating requires evidence of “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.” The NARSUM examiner noted that his condition had improved with medication and therapy, and opined a good prognosis assuming that he continued his participation in treatment. The C&P examiner noted his symptoms had improved and were mild in the absence of continued treatment. The commander noted that he had not observed the CI’s day to day emotional or mental state, and therefore, could not address occupational impairment related to his mental condition, but noted that since the CI could not handle a weapon he could not perform his duties as a Soldier. The commander statement also associated his emotional condition with the onset of marital issues. The Board considered the absence of hospitalization after the March 2005 hospital admission, absence of visits to the emergency room for mental health treatment, and stability of symptoms at the time of C&P exam with absence of active post-service treatment. The Board also considered the presence of social activity, decreased marital issues with the initiation of a new relationship, and full-time employment. The Board majority concluded his condition at the time of separation most closely reflected the 10% level of disability for “Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.” After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), and the application of §4.130, the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the mood disorder with elements of PTSD 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 mood disorder NOS with elements of post-traumatic stress condition and IAW VASRD §4.130, the Board by majority vote recommends no change in the PEB adjudication. 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 20131203, w/atchs
Exhibit B. Service Treatment Record

Exhibit C. Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXXXX, AR20150015857 (PD201302572)

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:

Encl                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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AF | PDBR | CY2013 | PD-2013-02572

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