RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00929
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150505
SEPARATION DATE:  20090916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a drilling Air National Guard E-5 (Supply Master Craftsman) medically separated for major depressive disorder (MDD).  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty.  She was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “depressive disorder recurrent severe w/psychotic features in full remission,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “major depressive disorder, recurrent, severe, w/psychotic features, in full remission” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Because my depression and anxiety continues and has hindered my attendance at my employment.”

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 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 20090224	VA* - (~26 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depressive Disorder, Mild	9434	10%	20070322 	
Other x 0 (Not in Scope)	Other x 0		
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070330 and 20090915 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Major Depressive Disorder (MDD).  The record indicated that the CI sought medical care for depressive symptoms in 2003 while on active duty.  She was successfully treated with two psychoactive medications for depression/anxiety with panic attacks.  In May 2006, she had a psychotic episode (paranoia and delusions) requiring emergency treatment.  In July 2006, her diagnosis was “major depression with psychotic features, recurrent” and her Global Assessment of Functioning (GAF) was 55 (in the moderate symptom range).  Her civilian psychiatrist stated, “she remains unable to work now and in the foreseeable future.”  Additional medications and therapy were begun and were considered effective for treating her diagnosed MDD.

An April 2008 memo from the CI’s VA treating psychiatrist indicated the CI was compliant on medications, undergoing counseling, had no relapse of symptoms and continued to work at two jobs.  Her diagnosis was major depression in remission and her GAF had improved to 75 (if symptoms are present they are transient and expectable reactions to psychosocial stressors; no more than slight impairment in social, occupational, or school functioning).

The narrative summary (NARSUM) addendum stated that the CI’s condition was stable “only with anti-depressant, anti-psychotic and anti-anxiety medications …” and disqualification for military service was recommended.  The commander’s statement, in July 2008, indicated the CI could perform all of her required tasks and that she was motivated; the commander recommended return to duty.

At the VA Compensation and Pension exam performed in March 2007 (26 months prior to separation), the CI reported her psychiatric history as above and she was on medications.  She was engaged, had friends, and planned to attend school.  Her sleep, appetite and energy were good without panic attacks or hallucinations.  Her mental status exam indicated a short attention span but was otherwise normal.  The diagnosis was MDD, mild and the GAF was 65 (mild symptom range) with the examiner stating that the CI’s “major depression would equate with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks and that in general she is functioning satisfactorily.”  As noted above, the VARD, dated 30 March 2007, rated this exam at 10%.  The VARD, dated 15 September 2009 (3 months after separation), considered added service treatment records and administrative records and continued the 10% VA rating.

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the CI’s MDD at 10% coded 9434.  The Board adjudged that there was insufficient evidence that the CI’s MDD was due to a highly stressful event for rating IAW VASRD §4.129 (mental disorders due to traumatic stress).

All members agreed that the §4.130 threshold for a 50% rating was not approached and that the criteria for a 0% rating were exceeded.  The deliberation settled on arguments for a 10% versus a 30% rating recommendation.  The 2007 VA exam may have approached the 30% criteria; however, by the NARSUM addendum evaluation in 2008, which was closest to the date of separation, the CI’s condition had stabilized and improved.  The examiner and PEB indicated that the MDD was considered in remission on chronic medication.  There was insufficient evidence of occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks to warrant a 30% 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 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 MDD 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 20140219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXXXX:
	
Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00929.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR