RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-02036
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140805
SEPARATION DATE:  20040423

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (2A573B/Aircraft Instrument and Flight Control Specialist) medically separated for a depressive disorder, not otherwise specified (NOS) condition.  The mental health condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued an S4 profile and referred for a Medical Evaluation Board (MEB).  The MEB submitted depressive disorder NOS, partner relational problem, nicotine dependence (Axis I conditions) and dependent personality disorder (Axis II condition) to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB (IPEB) adjudicated “depressive disorder” as unfitting, rated 10% (20% deduction applied for aggravating/contributing factors), citing criteria of the Department of Defense Instruction (DoDI) 1332.39 and the Veterans Affairs Schedule for Rating Disabilities (VASRD).  Dependent personality disorder and nicotine dependence were adjudicated as Category III conditions (not separately unfitting and does not contribute to the unfitting condition).  The CI appealed to the Formal PEB (FPEB) which affirmed the PEB findings and rating.  The CI did not agree with the FPEB findings and submitted a written appeal.  The written appeal was reviewed by the Secretary of the Air Force Personnel Council (SAFPC).  The findings and rating were affirmed by SAFPC and the CI was separated.

CI CONTENTION:  “Please consider all conditions”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting depressive disorder condition is addressed below.  The dependent personality disorder and nicotine dependence conditions were not separately ratable or compensable and therefore are not within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service FPEB – Dated 20040113	VA - (3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depressive Disorder	9434	 30%
-20%*
10%	Major Depressive Disorder	9434	30%	20040706	
Dependent Personality Disorder	Category III	Dysthymic Disorder	9433	NSC	
Nicotine Dependence	Category III	No VA Entry	
Other x 2 (Not in Scope)	Other x 1	
Combined:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20040902 (most proximate to date of separation [DOS]). *The PEB applied a 20% deduction for aggravating/contributing factors.
ANALYSIS SUMMARY:

Depressive Disorder Condition.  The psychiatric narrative summary (NARSUM) recorded that the CI had two psychiatric in-patient admissions.  The first admission in October 2002 was due to suicidal thoughts.  His second admission in September 2003 was the result of a suicide attempt.  The NARSUM was conducted on the in-patient unit for the second admission.  The NARSUM noted that the CI began treatment with Celexa after the first admission and discontinued it 2 months later, because he was doing so well.  At that time he was diagnosed with dysthymic disorder, depressive disorder NOS, and schizoid personality disorder, unspecified.  The CI participated in care at the life skills center where he was initially evaluated on 4 November 2002.  At that evaluation, his mental status examination (MSE) was normal and the examiner recorded the diagnoses of depression NOS, in remission; dysthymic disorder, and schizoid personality disorder.  The examiner noted the CI was taking an antidepressant medication (Celexa).  A mental health progress note dated 2 December 2002 recorded a normal MSE, “much improved symptoms,” and a history of suicidal ideation; however, no recurrent suicidal/homicidal ideation (SI/HI).  Treatment plan included continuing medication and encourage socialization.  The examiner noted the CI had limited social supports.  The next treatment entry dated 9 September 2003, recorded a one week in-patient psychiatry admission and a diagnosis of adjustment reaction.  Treatment records were scarce; however, treatment entry dated 24 October 2003, noted the CI had attended six classes to address mood management.  Until this point, the records demonstrated that all of the MSEs (four) were completely normal.

In the NARSUM dated 30 September 2003, the examiner recorded multiple stressors: his girlfriend was pregnant, he was undergoing a “report of survey” because his work toolbox was missing, he missed the delivery of the baby, which was a month earlier than expected, and he had significant financial stressors.  These events as well as others occurred approximately 2 months prior to the second hospital admission.  The examiner noted the CI and his girlfriend had many issues and on the night of the second admission, the CI, in the company of his girlfriend and a female friend, attempted to kill himself with alcohol and 409 cleaner before the others could stop him and call 911.  The psychiatrist noted the CI had a history of depressed mood, tearfulness over a period of a month associated with insomnia, he worried and felt guilty, had reduced concentration and appetite, felt worthless, and had suicidal ideation.  The examiner noted the applicant reported he attempted to cut his wrist because he believed his mother rejected and neglected him when he was 14.  At the age of 20, he considered overdosing on medications; his fiancé stopped him before ingestion.  MSE was unremarkable.  The psychiatrist diagnosed depressive disorder NOS, partner relational problem, and dependent personality disorder.  A Global Assessment of Functioning (GAF) score of 65 (mild) was recorded.

The CI underwent the VA Compensation and Pension (C&P) mental evaluation on 6 July 2004, approximately 3 months after separation.  The CI was engaged to marry, was not working, but was seeking employment.  He was not under treatment for his mental health condition and was not taking anti-depressant medication.  He reportedly stated his depressive symptoms tended not to last for long periods and noted that sleep, concentration and mood symptoms were not an issue at the time.  He continued to have “fleeting” thoughts of suicide; however, he had made no attempts or gestures since separation.  There was no indication that the CI was hospitalized since the September 2003 admission.  The CI noted he was socially engaged, was living with a roommate and the two went out to nightclubs on occasion.  The MSE recorded a slightly depressed mood and affect, but was otherwise unremarkable.  The examiner diagnosed major depressive disorder, recurrent, mild, deferred Axis II diagnosis; however, noted “probable personality issues.”  A GAF of 59 (moderate) was recorded.

The Board directs attention to its rating recommendation based on the evidence just described.  The Board first unanimously agreed that VASRD §4.129 was inapplicable in the absence of a highly stressful causative event.  The VA rated the condition diagnosed as major depressive disorder, coded 9434, at 30%.  The PEB assigned a disability rating of 30%; however, this was reduced to 10% after a deduction of 20% “for aggravating/contributing factors.”  Both the NARSUM and the C&P examinations reported similar MSEs.  The NARSUM examination indicated moderate level of occupational impairment for the military and noted there were mild stressors that had contributed to his condition with definite social and industrial impairment.  The PEB, in the remarks section of AF Form 356, stated “The IPEB notes member’s personality disorder….significantly affects the severity of his depressive symptoms.”  The CI entered an appeal to return to duty.  The FPEB opined that the CI’s depressive condition, especially with its risk for recurrence, was incompatible with the long-term rigors of military service.  The FPEB also agreed with the deduction and stated the deduction “for dependent personality disorder is appropriate.”  SAFPC agreed with the FPEB.  At the time of separation the Board agreed that the §4.130 threshold for a 50% rating (occupational and social impairment with reduced reliability and productivity) was not approached.  A rating of 30% requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The records noted the CI was hospitalized twice, responded well to medication, and his second hospital admission was in response to personal and financial issues.  The Board noted the CI responded well to medication, had fairly long periods of remission (11 months between hospitalizations), normal MSEs in between admissions, and a normal MSE during the 2003 admission.  All of the MSEs in the 6 months prior to separation were normal.  His therapist noted in November 2003 that his depressive condition had resolved.  There were no recorded panic attacks, and the commander’s statement, dated after the CI was discharged from the second admission, recommended retaining him.  The commander stated “He can work full shifts…is a valuable asset to the service.”  The C&P evaluation, 3 months after separation, recorded a normal MSE and noted the CI had not been in treatment since separation and had remained relatively symptom free.  All Board members agreed, his condition at the time of separation, did not support the 30% rating.  The 10% description, “occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or; symptoms controlled by continuous medication,” more accurately reflects the CI’s condition at separation.  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 NOS 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 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.

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 20140416, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2014-02036.

	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,

XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings