APPLICANT REQUESTS:  That the diagnosis for which he was rated during his physical evaluation board (PEB) be corrected to major depression and his disability rating be increased accordingly.

APPLICANT STATES:  That the condition for which he was rated, cyclothymia (a condition characterized by a predisposition to alternating moods of elation and mild depression) had never been mentioned anywhere in his medical records until his PEB.  He contends that his mental health records were received by the PEB the day prior to his hearing, and remained sealed; that none of the information contained in those records were used in determining his final diagnosis or rating.  If his medical records had been reviewed, the PEB could have arrived at no other diagnosis than major depression.  When he questioned the low rating he was assigned, members of the PEB told him that the lack of evidence of family crisis prevented him from receiving a higher rating, a criteria which is not contained in the VA Schedule for Rating Disabilities (VASRD).  Although he concurred with the findings and recommendation of the PEB, his concurrance was due to his military counsel discouraging him from appealing, possibly due to the proximity to Christmas.  In addition, he was fearful that he would be found fit for duty if he appealed.

In support of his application he submits copies of medical records, records which are incorporated in the evidence of record in the Board’s consideration.

EVIDENCE OF RECORD:  The applicant's military personnel and medical records show:

He enlisted in the Regular Army in pay grade E-3 on 26 May 1987, was awarded the military occupational specialty (MOS) of medical specialist, and was promoted to pay grade E-4.  He reenlisted on 14 June 1990 for 4 years for a service school which he successfully completed.  He was awarded the MOS of practical nurse and was promoted to pay grade E-5.  He reenlisted on 23 February 1994 for an additional 5 years.

On 8 October 1993 the applicant sought help from a military psychiatrist, stating that he questioned the validity of a diagnosis of major depression that was made on him at his last duty station.  At that time he reported that he had been mentally abused by his mother and physically abused by his father when he was a child, that his sister suffered from major depression, and that he had been “in detox” for cocaine and alcohol problems in 1984, but denied current usage.

On 2 November 1993 the applicant was given a Personality Assessment Inventory.  In that inventory it was said that a diagnosis of a major depressive episode should be considered, but paranoid schizophrenia, cyclothymic disorder, Post-traumatic Stress Disorder, organic mental disorder, borderline personality disorder, and antisocial personality disorder should be ruled out.

A medical evaluation board (MEB) evaluation was dictated on 3 November 1994.  In the MEB it is reported that as a child the applicant had headaches accompanied by blurry vision and photophobia, and had a violent temper until his mid-teens.

In the MEB dictation it continued that in March 1993 the applicant became depressed, manifested by gloomy thoughts, insomnia and weight loss.  He was treated for that depression, at first unsuccessfully.

The applicant had described himself as being in a cycle, wherein he may feel flighty, excited, and experienced racing thoughts, then feel surges of anger, tending to jump from one task to another and finding it difficult to stay on the job.  During that stage he would only sleep four to five hours a night and eat one meal.  After 3 or 4 days of that behavior, he would experience a 2 day cooling off period, which was followed by depression.

His condition had been stabilized with medication, and once regressed when he stopped taking the medication.

The physician conducting the evaluation for the MEB commented that the “patient exhibits physiological signs of anxiety, not of depression, which may account for equivocal response to Prozac.”  He then diagnosed the applicant as having cyclothymia and a personality disorder with elements of obsessive compulsive and passive-aggressive traits.  He was also diagnosed as having migraine headaches.  The MEB found him medically disqualified because, although his symptoms were controlled by medication, the medication is incompatible with continued military service because of its debilitating and possibly toxic effects under conditions of high output of energy and/or high environmental temperatures.

A formal PEB convened on 21 December 1994 and determined that the applicant was physically unfit due to cyclothymia, manifested by wide mood swings, periods of hypomania characterized by anger and aggressive outbursts, responded to lithium therapy, with anticipation of need for lithium ongoing, rated mild.  The PEB recommended that the applicant be discharged with severance pay due to medical unfitness, rated 10 percent disabled.

Accordingly, on 5 February 1995 the applicant was honorably discharged due to physical disability with $22,996.80 in severance pay.

DISCUSSION:  Considering all the evidence, allegations, and information presented by the applicant, together with the evidence of record and applicable law and regulations, it is concluded:

1.  Well prior to the applicant’s separation he was given a dual diagnosis.  The first was the possibility his condition stemmed from a major depressive episode and the second, if depression was ruled out, was the possibility that his condition was caused by either paranoid schizophrenia, cyclothymic disorder, Post-traumatic Stress Disorder, organic mental disorder, borderline personality disorder, or antisocial personality disorder.  The psychiatrist who evaluated the applicant during the MEB ruled out depression and determined that his symptoms were consistent with cyclothymia.  That diagnosis was not inconsistent with the earlier dual diagnosis.

2.  The Board notes that the applicant himself questioned the validity of his diagnosis of major depression prior to his MEB and PEB.
3.  In addition, the applicant’s condition appeared to have been well controlled by medication, that he was only determined medically and physically disqualified due to the volatile nature of his required medication under extreme conditions which could be encountered in the military.  Therefore, regardless of the diagnosis, a 10 percent disability rating would appear appropriate.

4.  In view of the foregoing, there is no basis for granting the applicant’s request.

DETERMINATION:  The applicant has failed to submit sufficient relevant evidence to demonstrate the existence of probable error or injustice.

BOARD VOTE:

                       GRANT          

                       GRANT FORMAL HEARING

                       DENY APPLICATION




						Karl F. Schneider
						Acting Director