RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-00066
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20071013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Armor Crewman) medically separated for major depressive disorder (MDD).  The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS).  He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB).  The “major depressive disorder (EPTS)” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition that met retention standards (chronic intermittent left knee pain) for PEB adjudication.  The Informal PEB adjudicated “major depressive disorder” as unfitting, rated 10%.  The CI made no appeals and was medically separated. 

CI CONTENTION:  The CI elaborated no specific contention in his application.  

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: 

IPEB – Dated 20070914	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder…	9434	10%	Mood Disorder with Depressive and Anxiety Features	9435	10%	20071219	
Other MEB/PEB Conditions x 1 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20080506 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

MDD.  The narrative summary (NARSUM) noted that the CI’s history of emotional struggles began after the death of his mother in 2001, which preceded his entry into the Army.  He completed a one year tour in Iraq (March 2005-2006), and re-enlisted in January 2006.  After the death of his mother in 2001, the CI did not seek mental health treatment, although he noted her death affected him greatly.  At the time of his enlistment in the Army, the CI reportedly felt clinically stable, but his symptoms of depression recurred while he was in Iraq.  He noted that he was exposed to several combat stressors, but had no major injuries related to combat.  He was recommended to seek assistance from the Combat Stress Team but he resisted.  After redeployment, he sought help from a civilian psychiatrist before transferring his care to military personnel in February 2007.  He was provided regular individual talk therapy and medication was implemented in June 2007.  The mental health evaluation dated 30 July 2007, indicated the CI had not been responsive to his medication and continues to experience depressed mood, lack of pleasure, isolation, insomnia, irritability, lack of energy, anxiety, problems with short-term memory and concentration.  He has bereavement issues related to his mother’s death.  Mental status examination was normal with the exception of flat affect.  Although the psychologist noted absence of signs or symptoms of “an organic mental impairment,” the diagnosis of MDD, single episode, moderate was recorded with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms or impairment).  The examiner also noted the condition was EPTS, and exacerbated by service.  

The VA psychiatric Compensation and Pension (C&P) exam was accomplished 2 months post-separation.  It was noted that the CI was seeking employment, and was supposed to attend college soon.  On MSE, the psychiatrist noted the CI did not appear to be interested in the evaluation process, and at times appeared irritable.  The examiner indicated the findings of the MSE were reflective of his level of disinterest and lack of motivation in the exam.  The CI reports ongoing problems with depression and sleep, but is not in treatment, and is not taking the prescribed psychotropic medications that he had been receiving because he reports that he did not feel that they were helping him.  The psychiatrist diagnosed mood disorder, not otherwise specified, and cognitive disorder, not otherwise specified.  In regards to his condition, the examiner wrote, “There would be signs and symptoms that are transient or mild and would decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.”  

The Board directed attention to its recommendations based on the above evidence.  The PEB rated the condition at 10%, citing “for symptoms controlled by continuous medication,” coded 9434 (MDD).  Likewise, the VA assigned a 10% rating, but used a different code (9435-Mood disorder NOS).  The Board first considered whether the provisions of VASRD §4.129 for any “mental disorder that develops in service as a result of a highly stressful event” were applicable to this case (as mandated by DoD).  All members agreed that his mental health (MH) symptoms did not constitute such an event.  Although the CI reported onset of symptoms during his deployment, the record demonstrated his symptoms preceded deployment.  It is possible that his symptoms might have been further aggravated by deployment, but they were not clearly the result of a service related highly stressful event.  The Board proceeded to rate under §4.130.  The higher rating of 30% requires evidence of “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”.  The MH consult, 3 months prior to separation, noted his symptoms had not adequately responded to treatment.  He was diagnosed with MDD, and despite medication his irritability and depressed mood had not significantly improved; however, his MSE was essentially normal.  The Board also considered the absence of objective findings related to cognitive deficits, falling asleep on the job, visits to the emergency room, or psychiatric hospitalization.  The C&P exam, 2 months post-separation, documented irritability, and noted the CI was in the process of attending college and had sought employment.  He was not in therapy or taking psychotropic medication.  His condition was opined to be mild, requiring medication that he had discontinued. 

After careful deliberation, Board members 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.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), and the application of §4.130, the Board 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.  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 major depressive disorder condition and IAW VASRD §4.130, the Board unanimously 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 20131220, 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, AR20160000307 (PD201400066)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA