RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00140
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070921

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve, E-4, Transportation Management Coordinator, medically separated by the Informal Physical Evaluation Board (PEB) for “depressive disorder,” with a disability rating of 10%.

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

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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 PEB - 20070724	VARD – 20080822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depressive Disorder	9434	10%	Posttraumatic Stress Disorder	9411	30%	20080115	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Depressive Disorder.  In July 2006, the CI was escorted to mental health (MH) after volunteering vague suicide ideations.  His specific complaint was against his superiors in that they are “cruel and rude” towards reservists like himself.  He additionally stated, “I see life different now” after being exposed to combat while deployed.  He was followed by psychiatry, treated with counseling and medications, but continued to be depressed and anxious.  Additional stressors as expressed in the case file included marital discord and parental issues.  His diagnosis was major depression; rule-out posttraumatic stress disorder (PTSD).  He was permanently profiled and referred to a Medical Evaluation Board (MEB).  There was no history of psychiatric hospitalization.  The MEB psychiatric narrative summary (NARSUM) dated 4 April 2007 (6 months before separation), noted no active suicide ideas or plans.  His mood was “depressed” and his affect was “constricted.”  His thought processes were logical, coherent and goal directed without flight of ideas or looseness of association.  Although he denied having nightmares after December 2006, he remained “…assaulted by the memory of a [Afghan] child collapsing in the dirt with blood pouring from his mouth.”  Additionally, the provider stated, “Contact with [the CI’s] unit commander usually causes a regression in [the CI’s] level of functioning, agitates the [CI] uncontrollably since the [CI] feels belittled and mistreated by his commander.”  His psychiatric AXIS I diagnosis was depressive disorder, not otherwise specified (NOS).
  
At the VA Compensation and Pension (C&P) examination performed on 15 January 2008 (4 months after separation), the CI’s mental status examination revealed a “good” mood, “normal” affect, and an “unremarkable” thought process.  There were no delusions, hallucinations, or thoughts of suicide and or homicide.  The CI answered ‘no’ to the question of having any disturbance that causes clinically significant distress or impairment in social, occupational or other important areas of functioning.  The VA provider documented that the CI did not meet the stressor criterion for PTSD and his diagnosis was listed as ‘deferred’ under AXIS I noting, ‘…final diagnosis is deferred until the stressor reported by the [CI] is verified by (Veteran’s Board of Appeal) VBA.’  A VARD dated 22 August 2008 noted a final 30% rating for PTSD with depressive disorder, NOS.  Another C&P examination’s medical opinion dated 18 August 2008 (11 months after separation) diagnosed PTSD and the same examination was listed on the 22 August 2008 VARD as evidence for the diagnosis.  

The Board directed its attention to its rating recommendations based on the above evidence.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for mental health (MH) conditions.  Both the PEB and VA listed depressive disorder as a diagnosis, whereas only the VA added PTSD as well.  The PEB assigned a 10% rating under the 9434 code (major depressive disorder) whereas the VA assigned a 30% rating using the 9411 code (posttraumatic stress disorder) based upon additional and more remote C&P evaluation.  The Board first considered if the definition of VASRD §4.129 was met for the unfitting MH condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.”  The Board noted that the CI’s occupational stressors, although considerable, were not comparable with the §4.129 criterion definition.  All members agreed that the main stressors in this case were directly related to the CI’s marriage and family concerns; and therefore, the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not satisfied.  The Board therefore will consider only the VASRD §4.130 impairment present at separation for a single rating recommendation. All Board members agreed that the findings of a “good” mood, “normal” affect, and an “unremarkable” thought process without delusions, hallucinations, or thoughts of suicide and or homicide was not supported above the PEB’s 10% impairment rating.  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 depressive disorder condition.  

BOARD FINDINGS:  In the matter of the 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.  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 20131230, 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 XXXXXXXXXXXXXXXXXX, AR20160005102 (PD201400140)

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