RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01979
BRANCH OF SERVICE:  Army	BOARD DATE:  20150702
SEPARATION DATE:  20050201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Wheeled Vehicle Repairer) medically separated for major depressive disorder (MDD).  The mental health (MH) condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent S4 profile and referred for a Medical Evaluation Board (MEB).  “Major depressive disorder” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other conditions (dysthymic disorder, headaches, shoulder pain, pes planus and correctable vision) as conditions not falling below retention standards.  The Informal PEB adjudicated MDD as unfitting rated 10%, with likely application of DoDI 1332.39.  The remaining five conditions were determined to be not unfitting and therefore not ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  He was not evaluated for sleep apnea.  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 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:

Service IPEB – Dated 20041223	VA - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depressive Disorder (MDD)	9434	0%	STR	
Other MEB/PEB Conditions x 5 (Not in Scope)	Other x 4	
Rating:  10%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20071231 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  The Board notes the earliest VA evaluation was 37 months after the date of separation.  DoDI 6040.44 provides for consideration of post-separation VA findings, particularly within 12 months of separation, although the Board’s recommendation is premised on the degree of disability at the time of separation.  Only VA evidence which can be reasonably interpreted to reflect disability at separation is probative to the Board’s recommendations.

Major Depressive Disorder.  The CI noted symptoms of depression, poor anger control and poor stress management beginning at his first duty station.  He was referred to anger management classes which did not help.  At his next duty station, he had similar feelings, yet was able to complete a 1-year deployment in Iraq.  While deployed, he had one or two counseling statements and began having suicidal ideation.  Upon completion of the deployment, his wife noted that he seemed depressed and encouraged him to seek help.  The CI initially self-referred to MH in June 2004.  Two months later, a psychiatric addendum noted while in Iraq he frequently heard mortars and gunfire in the distance, but he never came under fire by the enemy.  His job required him to be on the road frequently, with the ever present risk of ambush and improvised explosive devices.  He had been treated with individual and group psychotherapy and medications.  He had been on antidepressants for 2 months and had a moderate response.  His mental status exam (MSE) revealed a depressed mood with restricted affect.  His speech and thoughts were normal and he denied suicidal ideation.  He was diagnosed with MDD and assigned a Global Assessment of Function (GAF) of 55, moderate symptoms or moderate difficulty in social, occupational, or school functioning.  The examiner noted the CI responded to treatment but remained moderately symptomatic.  The commander’s statement documented the CI was able to perform common soldiering tasks and was working within his MOS with “fair” performance and had problems with motivation and purpose.  The narrative summary prepared 2 months prior to separation noted the CI was diagnosed with depression and started treatment with medications plus individual and group therapy.  He had some benefit but reached a plateau in a few months and was referred for a MEB.  The examiner referred to the psychiatric addendum for the remainder of the MH related information.  The VA’s initial 0% rating for the MDD was based on the service treatment records.  The first VA Compensation and Pension (C&P) exam was performed over 3 years after separation.  The CI reported the medications helped some while he was in the service.  When he got out of the service, his depression continued with the same level of symptoms; however, he was off his medications between March of 2005 and February 2007.  He reported that, off the medications, his depression was worse; when back on medications he improved being more calm, did not get frustrated as easily, did not feel pressured as much, and felt less depressed and nervous.  After separating from the Army, he obtained a Class A commercial driver’s license and worked for an oil field company for a year.  He was married in 1998 and had three children.  He reported his marriage was good with no significant problems at that time.  He reported that he got along pretty well with his children although he did get annoyed with them when he was not taking his medications for a while.  He maintained occasional contact by phone with siblings and parents who lived in Arizona and Oregon.  He did go to church most Sundays, was not making friends there, but he did feel comfortable around people there.  They did not go out with other couples.  When he had time, he liked working on his computer making greeting/business cards and desired to start a little business doing that.  He reported 10 hours of sleep a night and had gained 75 pounds since he separated from service.  He denied any panic attacks.  The MSE revealed slight psychomotor retardation.  His speech was somewhat slow with some decrease in volume, but normal tone.  His affect was appropriate with a depressed mood.  Concentration, thought processes, insight, and judgment were intact.  His remote and intermediate memory functions were okay, with a slight decrease in his recent memory functions.  No psychological testing was accomplished. The examiner assigned a GAF of 55 however this was over 37 months after separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB applied VASRD code 9434, MDD, rated 10% for “mild” which is terminology consistent with DoDI 1332.39.  The VA also applied code 9434, initially rated 0% citing “…based on slight symptoms of depression effective May 22, 2007….”  The VA increased the initial rating to 70% (effective 26 months after separation) based on the CI’s first C&P examination which was performed 37 months after separation.  Pertinent aspects of that C&P exam were summarized above, as it did contain historical information that reflected the CI’s level of disability around the time of separation.  The Board noted that despite the CI’s MH symptoms, he was able to successfully complete a one year deployment and always worked within his MOS with “fair” results.  There was adequate evidence that he did have some response to therapy although not enough for him to remain fit for duty.  The post separation evidence documented that he was continuously employed immediately after separation and had a stable family life.  He did have some social impairment in that he isolated himself, but was able to comfortably attend church on a weekly basis.  He reported good sleep habits and denied panic attacks.  It was well documented that when he took the prescribed anti-depressant medications his symptoms decreased.  There was no evidence that would allow for application of VASRD §4.129.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication 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 Major Depressive Disorder was operant in this case and the condition was adjudicated independently of that instruction by the Board.  In the matter of the MDD 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 20131028, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

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, AR20150015576 (PD201301979)

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						
						         
CF: 
(  ) DoD PDBR
(  ) DVA