RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00880
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20090419

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aviation Support Technician, medically separated for “major depressive disorder,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his condition should have been rated higher by the service.  He also contends a back condition which was not adjudicated by the service.  The CI’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 Physical Evaluation Board (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 based on 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 - 20081224	VARD - 20090519	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder…	9434	10%	Anxiety Disorder…	9413	50%	20090225	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).    The MEB narrative summary (NARSUM) was conducted in October 2008, approximately 6 months before separation.  The examiner recorded in the history of present illness, the CI’s emotional problems began in 2001 and he had intermittent periods of stability without the use of medication.  In 2007 he reportedly tried to hang himself in his garage, but the cord broke.  He was not hospitalized for this reported event.  Prior to this in 2006, he had thoughts of cutting his wrist.  There was no documented suicide attempts in the record.  In 2007, the CI was prescribed psychotropic medications for his symptoms of depressed mood, lack of energy, decreased motivation, sleep disturbance, and other symptoms suggestive of MDD.  In November 2007, he was assessed with chronic MDD with a rule out of cluster B personality traits and was started on a different anti-depressant medications.  At the time of the NARSUM, he was taking antidepressant medications and Seroquel for sleep.  It was noted that despite medication and therapy he had not improved much.  The examiner quoted his psychologist’s 2 January 2008 treatment note, which reportedly stated, “Although medication has been somewhat helpful for the patient, it is important to note that the patient is mostly benefiting from the expectation he will be discharged from the Navy.”  The examiner indicated that the CI had continued to have problems with mood disturbance, irritability, decreased concentration, decreased energy, tearfulness, and transient passive suicidal ideation (SI).  The CI reported his marriage of 7 years was good and they had no children.  The mental status examination (MSE) documented absence of psychomotor retardation or agitation, and irritable mood and affect; however, no evidence of psychosis, problems with memory, concentration, or judgment.  He denied SI and homicidal ideation (HI).  The diagnoses of MDD, recurrent, moderate, and personality disorder NOS [not otherwise specified] were assessed and a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms) was recorded.

The VA Compensation and Pension (C&P) mental exam was accomplished 2 months before separation.  At the examination, the CI reported in late 2006 he experienced suicidal thoughts during a down period.  He had planned to cut his wrists when he was home alone; however, noted he did not hurt himself because “he did not want anyone to be mad at him.”  He did not enter treatment at that point.  In mid-2007 he tried to hang himself with a “Cheap cord that broke.”  He told his wife and she asked him to talk to his command.  He saw a chaplain and psychologist.  He was started in therapy and had continued to see this therapist every 3 weeks until the present time.  The CI reported he continued his medication and that they were somewhat helpful.  He reported that 7-8 months ago he had some sleep difficulties which was treated with Ambien as needed.  The CI reported an incident with the Ambien.  He stated he had a bad day and was unable to sleep.  He took a handful of Ambien, which he clarified to mean he took 8 tablets, and was walking around the house with odd behavior.  He told his wife what he had done and they went to the emergency room (ER); however, he left before being seen.  He indicated he was unhappy that he was placed in a room and was not checked, thus, he walked out.  In addition to the depressive symptoms, he noted he had a negative opinion of himself, and believed that others did not think well of him.  He denied psychotic symptoms.  He reported a good relationship with his wife of 8 years and noted that they went to movies and plays, or to the beach about once a month.  He reported he believed that his stress level will decrease and that will help improve his situation.  The CI indicated he had plans to attend school on the GI bill once separated from the Navy.  MSE recorded that the CI was somewhat “brusque and irritable” during the interview and was only somewhat cooperative.  His mood was dysphoric, i.e., irritable and depressed.  His affect was recorded as “appropriate to immediate thought content and mildly labile”.  All other aspects of the examination were unremarkable, including absence of SI and HI, and absence of psychotic symptoms.  The examiner wrote, “See history of present illness” regarding history of paranoia.  However, evidence of a psychotic type paranoia history was not documented in the evaluation.  It was also noted that the CI had an infrequent history of panic attacks.  The diagnosis of anxiety disorder, NOS was recorded and cluster A personality features was noted on Axis II.  A GAF of 52 was assessed.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the condition of MDD, recurrent moderate, at 10% coded 9434.  The VA assigned a 50% rating for the condition diagnosed as anxiety disorder NOS, coded 9413.   All Board members first agreed that the preponderance of evidence did not support the application of §4.129.  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” due to  such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events.  The NARSUM did not record any panic attacks, deficits in memory, or periods of inability to perform occupational tasks due to mental health symptoms.  He reported chronic sleep problems; however, there was no documentation that supported occupational or social impairment secondary to lack of sleep.  The Board noted that his report of chronic transient, passive SI did not prompt any visits to the ER, nor did the record reflect any evidence of a suicide attempt.  The non-medical assessment report noted that the CI spent about 6 hours a week away from his duties for medical appointment; however, the command did not indicate that the CI had any mental health symptoms that interfered with his occupational functioning.   It was noted that because of his diagnosis he could no longer deploy and his inability to deploy had a negative impact on the mission. He was reassigned to administrative duties.  Although the CI reported significant irritability, there were no reports of aggressive behaviors in the community or at work.  

The Board acknowledged the findings at the C&P exam; however, there was no documented evidence at that exam nor in the service treatment record, of any psychotic symptoms, including paranoia, which was recorded in the C&P exam as “History of paranoia.”  The CI was given trials of various medications which was noted to have provided some benefit, and the evidence supported his depression had stabilized.  On 4 August 2009, 4 months after separation, he called the suicide hotline and reportedly stated, he called because “he is afraid he will get bad again and start having thoughts of suicide.”  Four days later, he presented to the VA emergency department with complaint of worsening anxiety and feeling down for the past several weeks.  He noted he was having problems with sleep, and that he had stopped all of his psychotropic medications 6-8 weeks ago.  He also noted that he had called the suicide hotline 4 days ago because “He wanted to get expedited help and get plugged into VA resources faster.”  He did not meet criteria for inpatient hospitalization, and he denied SI and HI.  He also refused to resume previous medication but was interested in group therapy.  The Board considered the evidence presented in the service treatment records, the NARSUM, the C&P exam, and the non-medical assessment.  All Board members agreed, the CI’s condition at the time of separation, most closely reflected the 10% level of impairment for symptoms that were transient and controlled by continuous medication.  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 MDD condition.  

BOARD FINDINGS:  In the matter of the Major Depressive Disorder, Recurrent-Moderate 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 20140224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 21 Jun 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						(Manpower & Reserve Affairs)