RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01812
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was active duty E3, Satellite Communications Systems Operator/Maintainer, medically separated for “major depressive disorder,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  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 - 20060222	VARD - 20060515	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Depression, Post-Traumatic Stress Disorder	9411	50%	20061030	
Attention Deficit/Hyperactivity Disorder NOS	Not Unfitting	No VA Placement	
Alcohol Abuse			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to the service treatment records (STR) and the mental health (MH) Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s first encounter with MH occurred while in AIT.  The Post-Deployment Health Assessment (PDHA) screen in 2003 and 2004, noted that he had not sought any MH treatment during deployment, and was not exposed to nor witnessed anyone wounded, killed or dead during deployments.  Although the CI reported he had increasing symptoms of anxiety and depression since his deployment, he did not endorse any MH symptoms in the 2004 PDHA screening.  There was no report of a traumatic stressor.  The CI developed a pattern of mood stability and instability, with symptoms of irritability, depressed mood, sleep disturbance, anger and anxiety, when faced with acute stressors.  Despite treatment, the major depressive disorder condition could not be adequately rehabilitated to meet the requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “major depressive disorder” for PEB adjudication.  

At the time of the MH clinic appointment on 2 December 2005, the CI’s report that “things were not going well at home.”  His wife, who still lived in Texas, talked about leaving him which led him to have thoughts of hopelessness.  He also begun to worry about a 3rd deployment to Iraq and “what it will do to his family life.”

The MEB NARSUM examination on 5 January 2006 (2 months before separation) noted that the CI self-referred to MH in September 2005 with the report of problems with feeling anxious, depressed, hopeless, lonely, frustrated, and overwhelmed.  He underwent psychological testing and evaluation and was assessed with an anxiety disorder and attention-deficit-hyperactivity disorder (ADHD).  He noted that he had problems since returning from deployment.  However, it was noted that the CI mentioned he had one visit to MH in Kuwait for anxiety, and problems with sleeping and irritability during returning medical examination, and was recommended to follow-up with MH services.  The CI also noted that his deployment had caused marital strain.  When he returned from deployment, his wife had moved to Texas, and later became pregnant as the result of an affair.  It was noted that in addition to his emotional issues, the CI was struggling with weight issues and was part of the overweight program for 4 years without success. 

Additionally, during the MEB examination, the CI reported he continued to have ongoing problems with depression and anxiety.  He noted that at one point he was being considered for separation due to his weight.  He noted that he felt very discouraged about his future career.  He was feeling at that time hopeless and helpless, trying to lose weight.  His situation was compounded by the geographic separation from his wife.  Also at the time he was receiving counseling which he felt was helpful.  The examiner noted that he had made minimal progress with his depression and anxiety, worsened by the CI learning (while in Texas for Christmas) that his wife had an affair and was pregnant.  He was upset and brought his two children home with him.  In addition to talk therapy, the CI also took an antidepressant medication.

The CI noted that during his first deployment to Kuwait, he was exposed to live fire, missiles, and “watching dead bodies.”  He felt fearful for his life but was able to “move on.”  The mental status examination (MSE) noted that the CI looked “very tired and eyes were bloodshot.”  He was fidgety, and described his mood as “mixed,” both angry and sad.  His affect was angry and sad, and his thought processes were “entirely focused on the event over the Christmas holiday.”  There was no evidence of psychosis, impairment in thinking or judgment, or cognitive deficits.   Suicidal or homicidal ideation was absent.  The diagnoses of post-traumatic stress disorder (PTSD), depressive disorder not otherwise stated (NOS), attention deficit/hyperactivity disorder (ADHD), and alcohol abuse.  The CI was also assessed with cluster B personality traits.  The examiner noted that his current stressor was partner relationship problem, and assigned a Global Assessment of Functioning (GAF) score of 50 (serious symptoms/impairment).  The examiner noted that the CI was not fit for duty IAW 40-501, section 3-32 (mood disorders).

A memorandum to the PEB was prepared by the NARSUM psychiatrist in response to the PEB’s inquiry regarding the PTSD diagnosis assessed at the NARSUM.  The memorandum dated 16 February 2006, 1 month prior to separation, documented the CI had been in treatment for the primary clinical concern of depression, and that his diagnosis was MDD, single episode, moderate as the primary diagnosis and not depressive disorder NOS.  The examiner stated “that his condition of MDD, single episode moderate, 296.22, is the primary clinical issue and renders him unfit for further duty.”
At the 30 October 2006 VA Compensation and Pension (C&P) mental examination, performed 7 months after separation, the CI noted he was not in MH treatment and had full custody of his two children.  The CI noted that he had no social life, and had anxiety attacks, felt stressed, and had considered suicide “many times.”  He was working full-time.  He denied any problematic substance abuse history, but noted that in October 2006 he was arrested for public intoxication.  The CI’s MSE noted that he focused his thoughts on intrusive memories and thoughts of the war which occurred “2 times a week.”  He denied psychotic symptoms, and his eye contact was noted to be “sporadic.”  The CI stated he had poor focus, poor concentration, problems with short-term memory, and that he had panic attack about 2 months prior.  He also reported sleep disturbance and depressed mood.  A GAF score of 55 for moderate symptoms or impairment was recorded.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the major depressive disorder condition 10%, coded 9434 (MDD), citing moderate symptoms of anxiety and depression during deployment, rated as mild industrial impairment.  The PEB also noted that the condition did not result from a combat related injury.  The VA determined the condition as “depression, post-traumatic stress disorder” rated 50%, coded 9411 (PTSD), citing pre-stabilization rating for unhealed or incompletely healed wounds or injuries, with it being likely there will be material impairment of employability.  

First, the Board noted there was no specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress.  A specific service related traumatic stressor was not documented by any of his treatment providers, or the NARSUM psychiatrist, and was not endorsed by the CI in either PDHA screens.  The commander’s statement made no mention of a combat related stressor.  All Board members agreed the provisions of §4.129 were not applicable.  The Board reviewed the evidence and proceeded to rate under VARSD §4130.  The NARSUM recorded absence of psychiatric hospitalizations and a MSE that was essentially normal.  The record demonstrated a pattern of symptom stability controlled by medication, and a pattern of acute worsening of symptoms in response to transient stressors.  The record demonstrated absence of crisis treatment, emergency room treatment, hospitalization, panic attacks, suicidal gestures or attempts, aggression or violence.  The Board noted the inconsistencies documented at the C&P examination, and the reported worsening of symptoms, but considered the CI was gainfully employed, had taken on the responsibility of childcare, despite the absence of any form of MH treatment.  There were no MH treatment records after separation available; however, 1 month after the C&P examination, the CI reported he was still employed with the same employer.  The CI did not indicate that he was having any MH related issue interfering with his job performance, and noted that he was not receiving any MH treatment.

The commander’s statement noted that his performance since his separation from his wife had deteriorated.  He exhibited a lack of motivation and focus.  “His thoughts are on his children and not the military.”  The Board noted that despite the reported decline in his condition, the record demonstrated the CI was able to work, and remain relatively stable. The Board also noted the transient nature of his condition, and the temporal relationship of his symptoms to life stressors.  After considerable deliberations, Board members concluded, at the time of separation, the CI’s condition was most reflective of the 10% disability level for transient symptoms which decrease 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. 

Contended PEB Conditions:  Attention-Deficit-Hyperactivity Disorder NOS and Alcohol Abuse.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the major depressive disorder condition and IAW VASRD §4.130a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended attention deficit hyperactivity disorder and alcohol abuse conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20150613, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

SAMR-RB						

14 NOV 2016

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, AR20160016544 (PD201401812)

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