RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-01505
BRANCH OF SERVICE: Army                                                                   SEPARATION DATE:  20050622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “major depressive disorder” with a disability rating of 10%.  

CI CONTENTION:  The CI requested a review of his initial claim from when he separated.  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 upon a 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 - 20050421	VARD - 20051011	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depressive Disorder	9434	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  None	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to service treatment records (STR), the CI deployed to Iraq from January to July 2003.  After his return, he felt more irritable and depressed.  He visited a community health emergency room in June 2004 and reported he was feeling depressed and having nightmares about what had happened in Iraq for the past month and a half.  He felt he was getting worse, didn’t feel like himself, didn’t hang out with friends, and “had stuff going on” back home.  He had been arrested 6 months previously for disorderly conduct. The CI denied a history of psychiatric, legal, or mental problems prior to deployment to Iraq.  He believed he had adapted well to military life until his deployment.  A diagnosis of posttraumatic stress disorder (PTSD) was rendered and he was referred to mental health for follow-up.  He attended only three visits and was not started on psychotropic medication.  
The Medical Evaluation Board (MEB) narrative summary (NARSUM) was based on serial mental status examinations from 17-25 January, 2005.  The CI was referred to inpatient psychiatry unit January 17, 2005 after self-admitting to an emergency room where he reported he attempted to commit suicide by shooting himself in the head with a loaded gun.  He had been recently told that he was to deploy to Iraq again in a few days.  The next day he developed suicidal ideation.  The CI reported he retrieved his loaded gun from a friend and less than 12 hours prior to departure to Iraq, attempted to shoot himself in the head but the gun did not fire.  He denied suicidal ideation, stating he just wanted to feel better.  He denied previous suicide attempts or psychiatric history.  The CI reported he had multiple recent stressors, including trouble at work due to a variety of infractions, a decline in his work performance, concern about his finances, the health of himself and his parents, and recent arguments with his girlfriend of 2 years.  He was having difficulty sleeping, decreased appetite, energy and concentration, and guilty feelings that he was letting his family down.  He was taking one medication for depression as well as a sleep aid per medication profile.  His mental status examination (MSE) showed an affect that was mood-incongruent at times, smiling and laughter while discussing his depression and near-fatal suicide attempt.  He showed moderate improvement on the inpatient ward but continued to have symptoms of depression that were impairing his ability to perform his military duties.  A diagnosis of major depressive disorder (MDD) was rendered with a Global Assessment of Functioning (GAF) of 65 (mild symptoms, impairment.)  

At the MEB examination, DD Form 2807-1 Report of Medical History, dated January 2005, the CI reported he was suffering from depression, trouble sleeping, and anxiety based on events that took place in Iraq during 2003.  He was taking anti-depression medicine every morning.  He was assigned an S3 profile.  

The commander noted the CI was part of a unit that conducted deployments both in-garrison and combat environments.  He had performed his duties sufficiently to be considered an asset to any Infantry Rifle Squad or team but stated, “He was pending charges for numerous accounts of dereliction of duty and disobeying a lawful order prior to his suicide attempt and missed several treatment appointments.  He has continued to perform at a substandard level and accept responsibility for his actions, a liability to the unit and his fellow soldiers, attempted to avoid deployment, should be separated under a punitive chapter and forfeit all benefits, recommend he be found fit for duty and not separated under the provisions of a medical board.” 

A note recorded by the PEB medical doctor, dated 21 April 2005 (same day as the PEB proceedings) documented the conversation he had with the CI’s psychiatrist which noted the CI was being followed as an outpatient and treated with anti-depression medication and a sleep aid.  He was continuing to experience some depression symptoms.

The CI did not report for his VA Compensation and Pension (C&P) examination in 2005.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD condition 10%, coded 9434 (major depressive disorder), citing mild social and industrial impairment.  The VA denied the CI’s claim for service connection of the MDD condition, coded it 9434 (major depressive disorder), citing that the CI did not attend his scheduled examination. The Board, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD 4.129 to all Board cases as appropriate), agrees that the stipulations of §4.129 are not met in this case due to the lack of evidence of specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress.  The Board then considered if there was evidence for a §4.130 rating higher than the 10%.  The §4.130 criteria for a 10% rating is “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, or; symptoms controlled by continuous medication,” for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  All Board members agreed, the CI’s condition at separation had stabilized. The record demonstrated that after the CI’s January 2005 hospitalization, he had no additional hospitalizations and no outpatient visits in record for the next 6 months leading to separation, and that there was no post separation evidence available because the CI did not report to his VA exam.  The Board also noted the transient nature of his condition, and the temporal relationship of his symptoms to life stressors (notification for deployment).  Board members concluded, at the time of separation, the CI’s condition was best reflected in the 10% disability rating for “Occupational and social impairment due to transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress.”  After due deliberation, and 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 major depressive disorder condition.

BOARD FINDINGS:  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.  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 20140327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX AR20160013471 (PD201401505)

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