RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-02075	
BRANCH OF SERVICE:  NAVY 	 BOARD DATE:  20150701
SEPARATION DATE:  20061127		 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Hospital-man) medically separated for bilateral knee pain and major depression.  These conditions could not be adequately rehabilitated to meet the physical requirements of his Rating.  He was placed on light duty and referred for a Medical Evaluation Board (MEB).  The bilateral knee pain and major depression conditions, characterized as “pain in joint, lower leg” and “major depression,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB, and a subsequent Reconsideration PEB, found the CI fit for continued active duty.  Following a CI appeal, the Formal PEB (FPEB) adjudicated “patellofemoral pain syndrome right greater than left (category I)” and “major depression, recurrent (category I)” as unfitting, rated 10% and 10%.  Additionally, the FPEB adjudicated “anxiety disorder, not otherwise specified (category II)” as a condition that contributed to the major depression.  The FPEB also determined “pseudofolliculitis barbae (category III),” “right shoulder slap lesion (category III),” “alcohol abuse, status post treatment (category IV)” and “nicotine dependence (category IV)” conditions to be not unfitting.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “Please consider all conditions found unfitting and not unfitting by the physical evaluation board.” 

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 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 FIPEB – Dated 20060808	VA - (4.6 yrs/Post-Separation)*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Pain Syndrome, Right Greater than Left (Category I)	5299-5003	10%	Residuals, Right Knee Arthroscopy Miniscetomy	5259	10%	20070413	
			Left Knee Condition	5298-5261	NSC	20070413	
Major Depression, Recurrent (Category I)	9434	10%	PTSD (Claimed as Anxiety and Depression)	9411	10%	20070413	
Anxiety Disorder, NOS** (Category II)							
Pseudofolliculitis Barbae (Category III)			Pseudofolliculitis Barbe	7813	NSC	20070413	
Right Shoulder Slap Lesion (Category III)			Right Shoulder Strain	5299-5201	20%	20070413	
Other MEB/PEB Conditions x 2 (Not In Scope)	Other x 3	
Combined:  20%	Combined:  50%	
*Derived from VA Rating Decision (VARD) dated 20110526.   
** Not Otherwise Specified (NOS)

ANALYSIS SUMMARY: 

Bilateral Knees.  Notes in the service treatment record (STR) indicated the CI first presented on 3 June 2004 with the report of knee pain.  He noted that his pain had begun during his deployment to Afghanistan; however, he had not sought care.  He described pain in both knees that increased with prolonged standing and with running.  He was initially thought to have illiotibial band syndrome.  The CI had received conservative treatment that consisted of physical therapy, ice, rest, range-of-motion (ROM) exercises, and non-steroidal anti-inflammatory medications.  In October 2004, a sports medicine specialist diagnosed him with bilateral patellofemoral syndrome and ordered additional physical therapy.  Treatment entry dated 26 October 2004 documented the CI report of bilateral knee pain of 6 months duration, right significantly greater than left.  The examiner noted full ROM in both knees; however, documented that the CI was in “obvious” pain during right knee ROM testing and was almost tearful during the examination of both knees.  The examiner stated, “because of his pain and apprehension out of proportion to history and exam, consider PTSD workup”.  On 5 January 2005, orthopedic examination noted that the magnetic resonance imaging (MRI) of the right knee demonstrated a plica with possibility of meniscal tear.  The CI was scheduled for arthroscopic surgery.  During the pre-operative examination, the CI reported his left knee had begun to bother him “a little more”.  On 10 February 2005, the CI underwent right knee surgery without complication and diagnosed with right knee medial meniscus tear and synovitis.  

The narrative summary (NARSUM) dated 2 February 2006, noted the CI received post-surgery physical therapy for several weeks.  Approximately 6 weeks into therapy, he complained of continued right knee clicking, swelling as well as pain in both knees; his therapy was extended until September 2005.  The CI’s orthopedist reported in October 2005 that the right knee was still in the healing process and more therapy was required.  After a year on the limited duty profile, the CI continued to report bilateral knee pain, right leg greater than left.  A repeat MRI of the right knee demonstrated possible tear of the anterior horn of the lateral meniscus.  Surgery was again considered; however, the surgeon opined that surgery would not help his symptoms and that he would continue to have chronic right greater than left knee pain “most likely associated with PFS.”  Physical examination documented “full” ROM in both knees and no evidence of effusion, swelling or erythema.  Crepitance was noted in the patella of both knees during ROM; however, pain on motion was not reported.  There was no evidence of instability in either knee.  The examiner recorded diagnoses of bilateral PFS, and chronic right knee pain status post right knee arthroscopy for medial plicae.  It was noted that the CI was able to perform his duties in his job in physical therapy; however, he was unable to deploy due to decreased ability to stand for prolonged periods of time, carry a large pack and to run.

At the VA Compensation and Pension (C&P) examination on 13 April 2007, approximately 5 months after separation, physical examination recorded the CI walked with a slight limp on the right leg, and ROM flexion to 135 degrees (140) each knee, and extension of 0 (0).  There was no evidence of instability in either knee, and muscle strength was slightly decreased in both lower extremities without noted atrophy.  Radiographs of bilateral knees were normal.  The CI reported that he could ambulate without assistive devices, and he had no significant limitations on walking.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral condition as a single unfitting condition at 10% under the analogous code 5299-5003 (degenerative arthritis).  The VA used the 5259 code (cartilage, semilunar, removal of, symptomatic) to rate the right knee at 10%.  The left knee was not service-connected.  As noted below, the Board placed the CI on a constructive TDRL period of 6 months for his MDD with anxiety disorder NOS; therefore, the TDRL period applies to the bilateral knee condition as well.  Although VASRD §4.71a permits combined ratings of two or more joints under code 5003, it allows separate ratings for separately compensable joints.  IAW DoDI 6040.44 the Board must follow suit if the PEB combined adjudication is not compliant with the latter stipulation, provided that each ‘unbundled’ condition can be reasonably justified as separately unfitting in order to remain eligible for rating.  If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  The Board then proceeded to the rating of the right knee condition.  At the time of constructive TDRL placement, the commander’s statement, 6 months prior to separation, documented the CI was able to perform assignments; however, his physical condition impacted his ability to continue in the Service.  The commander commented on his right knee interfering with his ability to remain in the Service and made no mention of a left knee condition.  The NARSUM documented that the CI’s LIMDU was extended due to the orthopedist report that his right knee was still in the healing process and he needed additional physical therapy.  The record documented right knee with full ROM, no evidence of instability, or functional loss.  The NARSUM noted several months after surgery, a right knee MRI demonstrated a possible meniscus tear; however, surgery was not warranted since it was felt that surgery would not improve his reported pain symptom, opined to be associated with PFS and not the tear.  Although the CI reported right knee locking there was no objective finding of knee locking, therefore, based on the evidence Board members agreed that the record sufficiently documented right knee pain and supported a compensable rating under the 5003 code, and that a rating under the 5259 code, although, appropriate, would not result in a rating higher than 10% (maximum allowed under the code).

The Board agreed that the condition was not compensable under ROM codes 5260 and 5261, or any other applicable VASRD code.  The VA C&P exam was the sole source document to consider at the end of the TDRL period.  The VA C&P examination documented pain on motion; however, rated the right knee for the removal of the meniscus.   The Board noted the 5259 code was the only knee code applicable to this case, and allows for only the minimal compensable rating, and therefore, since the code offers no additional benefit to the CI, Board members agreed no changes should be made to the coding.  The Board next proceeded in rating of the left knee condition at TDRL placement.  As noted above the VA did not service-connect the left knee, therefore, the NARSUM and the available treatment record are considered the source for rating at both TDRL placement and removal.  A careful review of the records in evidence demonstrated treatment of pain predominately in the right knee.  There was only one entry that reported pain in the left knee of intensity 1-2/10, recorded a year prior to separation; no entries recorded the report of left knee pain as a single complaint.  Thereupon, the Board opined, the left knee pain was milder than the right.  The NARSUM recorded the CI pain was worse in the right knee, and the one entry that recorded left knee pain intensity 1-2/10, indicated minimal pain.  The Board agreed that the preponderance of evidence did not support a compensable rating under code 5003 for the left knee.  The Board opined the left knee was not compensable IAW §4.71a for ROM or instability.  The Board unanimously agreed the left knee did not rise to a level of compensability under §4.59 or §4.40.  The Board was unable to find any additional codes for consideration.  Thereupon, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 0% for the left knee pain condition at TDRL placement and removal, and 10% for the right knee pain condition at TDRL placement and at permanent separation.  As this result in no rating benefit to the CI, the Board recommends no recharacterization of the PEB adjudication for the bilateral knee condition. 

Major Depression (Subsumes Anxiety Disorder).  The psychiatric NARSUM examination was completed 9 months prior to separation and was conducted by his treating psychiatrist.  It was documented that during the 2003 deployment to Afghanistan, the CI was exposed to a traumatic situation involving the wounding of civilians and a few Marines.  After returning from Afghanistan, he reportedly developed depression and anxiety.  His depressive symptoms consisted of sadness, decreased concentration, sleep and appetite, and decreased motivation.  He also reportedly experienced feelings of hopelessness and social isolation with decreased interest in pleasurable activities.  Suicidal and homicidal ideation was not among his symptoms.  He was treated with medication and his symptoms improved but waxed and waned, never achieving beyond partial remission.  The CI had also reported being nervous around people after returning from deployment.  He was sensitive to being yelled at and loud and chaotic situations which had never bothered him in the past had become an issue.  At the time of the psych NARSUM exam the CI’s symptoms could best be described as moderate to severe.  The mental status examination documented decreased motor activity, depressed mood, and “significantly” blunted affect; all other aspects were within normal limit.  The examiner recorded the diagnoses of major depression, recurrent (MDD), moderate to severe, and anxiety disorder NOS, with a global assessment of functioning (GAF) score of 55-60 (moderate).  The examiner noted his mental health condition rendered him unemployable and unfit for full duty.  

The VA C&P mental examination, 5 months after separation, documented that the CI was unemployed and was a full-time college student at the university seeking a Master’s degree.  He lived alone and was not in any significant relationship.  The CI had no history of psychiatric hospitalizations or suicidal/homicidal thoughts, and he was in the process of beginning mental health treatment at the local VA for PTSD.  He had continued his antidepressant medications, but noted his symptoms of PTSD and some depression had continued.  MSE was unremarkable except for mildly anxious mood and constricted affect.  The examiner opined that the CI’s evaluation was consistent with the diagnosis of “chronic and currently mild to moderate PTSD with some associated depression.”  The examiner noted that the CI was performing generally well in school, had some mild sleep impairment, and had a fair to good prognosis.  His GAF was assessed at 66 (mild) and the diagnoses of PTSD and depressive disorder NOS, both mild to moderate, were recorded. The examiner documented several combat-related stressors, and noted that the CI “served as a corpsman and took care of a lot of wounded people, and he felt like he was in combat the entire time he was in Afghanistan.”  The commander’s statement documented in the non-medical assessment (NMA) did not reference any mental health condition, but did mention his right knee condition.  Although the NARSUM examiner recommended a mental health LIMDU, the record in evidence does not reflect limitation related to mental health.

The Board directed its attention to the rating recommendation based on the evidence just described.  The Board first addressed the Category II condition.  The VARSD requires that all mental health conditions be rated IAW §4.130 (schedule of ratings for mental disorders) and is based on impairment independent of diagnosis.  Therefore, the Category II condition of anxiety disorder NOS was subsumed under the unfitting Category I condition of MDD, and thus, so rated.  The PEB rated the condition of depression, coded 9434, at 10% with the likely application of SECNAVINST 1850.4E.  The VA rated the condition as PTSD coded 9411 at 10% based on §4.130 criteria.  Although the VA examiner diagnosed PTSD, no specific stressor was identified, and there was no clear evidence that DSM-IV diagnostic criteria was met; specifically, Criterion A and C.  Additionally, the CI responded “No” to all PTSD related symptoms in the April 2004 Post-Deployment Health Assessment (PDHA) screen, approximately 4 months after re-deployment, and PTSD symptoms were not identified in the service treatment record or the NARSUM.  The NARSUM noted that the CI had not sought mental health care until the summer of 2005.  All Board members agreed there was insufficient evidence to support a diagnosis of PTSD.  Neither the PEB nor the VA elected to apply VASRD §4.129, defined as “a mental disorder that develops in service as a result of a highly stressful event [that] is severe enough to bring about the veteran’s release from active military service.”  The Board considered if the application of the provisions of 4.129 was applicable.  The PEB noted that the unfitting conditions were not combat-related.  Both C&P and NARSUM examiners specifically stated his condition presented after exposure to traumatic events during deployment.  The Board noted that the NARSUM recorded medical and routine military service stressors; however, the examiner stated, “He was exposed to a traumatic situation of wounded civilians and a few Marines.  After returning from Afghanistan he developed depression and anxiety.”  The Board also noted the PDHA screen demonstrated “Yes” responses to the question of traumatic exposure and fear of being killed.  The VA examiner also recorded combat-related stressors, and opined that the CI’s mental health condition was the result of his deployment experiences.  The Board concluded there was sufficient evidence of a specific highly stressful event.  After considerable discussion, the majority of the Board members agreed that the provisions of §4.129 applies in this case.  Therefore, the Board in compliance with the provisions of VASRD §4.129 (mental disorders due to traumatic stress), recommends placement of the CI on a period of constructive TDRL with a minimum rating of 50% IAW §4.129 with reassessment after 6 months.  The higher 70% rating criteria requires evidence of “Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.  Available treatment records prior to constructive TDRL period recorded absence of history related to psychiatric hospitalization, or emergency room treatment.  His MSE at the NARSUM was essentially normal without documentation of impairment in thinking or judgment.  The NARSUM examination documented a poor prognosis for continued military duty, but civilian occupational prognosis was fair to good.  The Board considered a letter written to the PEB 5 months prior to separation, on behalf of the treating psychiatrist who was at the time deployed.  That letter noted that the CI’s depressive symptoms had not responded well to treatment and that he “continued to have a moderate to severe level of depression”; however, the author (non-treating clinician) opined that his condition caused “social and occupational impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks,” consistent with 30% disability rating.  

The Board concluded the record in evidence did not support a higher than 50% rating for TDRL placement.  The Board next determined the most appropriate fit with VASRD §4.130 criteria at the end of TDRL for its permanent rating recommendation.  The Board deliberated the evidence for the 30% versus 10% disability rating.  The 30% disability rating requires evidence of “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal) due to symptoms such as depressed mood, anxiety, panic attacks, chronic sleep impairment, and mild memory loss.  At the time of TDRL removal, the C&P examination was the only available evidence to rate the condition since that examination occurred 5 months after separation.  At the time of separation all members agreed that the §4.130 threshold for a 50% rating (occupational and social impairment with reduced reliability and productivity) was not approached.  The deliberation settled on arguments for a 10% versus a 30% permanent rating recommendation.  The 30% description (“occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”) is difficult to support given he was excelling as a full-time graduate student, but was socially isolated.  Although the C&P examiner recorded symptoms were mild-moderate, a GAF of 66 (mild, 60-69) was assessed.  The NARSUM noted that his depressive symptoms waxed and waned; however, post-separation evidence of greater than 4 years, noted stability of symptoms reflected in the CI’s accomplishments.  VA records noted that the CI completed his Master’s degree in Environmental Engineering in 2009, and worked as an intern in his field.  His MSEs were essentially normal at both the VA and NARSUM examination.  The CI was never hospitalized psychiatrically, panic attacks were absent, he never endorsed suicidal or homicidal thoughts, and he was never treated in the emergency department for mental health concerns.  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,” is a better fit with the CI’s condition at TDRL removal.  All evidence considered, there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s rating decision of 10% for the major depressive disorder condition at TDRL removal. 

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the pseudofolliculitis barbae and right shoulder were not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that either condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the pseudofolliculitis barbae and right shoulder conditions and so no additional disability ratings are recommended.

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.  As discussed above, PEB reliance on SECNAVINST 1850.4E for rating depression and bilateral knees was likely operant in this case and the condition was adjudicated independently of that instruction by the Board.  In the matter of the patellofemoral pain syndrome, right greater than left condition, the Board recommends an initial TDRL rating of 10% in retroactive compliance with VASRD §4.129 as DOD directed; and a 10% permanent rating IAW VASRD §4.71a.  In the matter of the major depressive disorder, recurrent, the Board recommends an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DOD directed; and a 10% permanent rating IAW VASRD §4.130.   In the matter of the contended pseudofolliculitis barbae and right shoulder 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 minority voter submitted the appended minority opinion. 

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified to reflect that the applicant was placed on the TDRL at 60% for a period of 6 months IAW §4.129, and then permanently separated with severance pay by reason of physical disability with a final 
20% rating as indicated below.  

UNFITTING CONDITION	VASRD CODE	TDRL RATING	PERMANENT
RATING	
Patellofemoral Pain Syndrome	5299-5003	10%	10%	
Major Depression, Recurrent	9434	50%	10%	
	COMBINED	60%	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140508, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

MINORITY OPINION – PD-2014-02075

The majority vote in this case recommends a constructive TDRL period based on application of VASRD 4.129, regarding the CI’s unfitting MH condition(s) (depression and anxiety).  I respectfully disagree with this consensus and present the following facts to support my opinion that the NAVY Physical Evaluation Board (PEB) correctly determined that the CI’s mental health condition was ratable at 10% in accordance with VASRD 4.130 and that it was not combat related and (by implication) did not develop in service as a result of a highly stressful event severe enough to bring about the CI’s release from active military service.  The following pertains:

•	The CI was a combat medic and as such, was presumably trained for exposure to the nature of trauma documented in the record.
•	The Formal PEB concurred with the Informal PEB and specifically annotated that none of the CI’s unfitting conditions were combat-related in accordance with Title 26 U.S.C 104 (b) (3).  This definition of combat relatedness is broad and includes personal injury or sickness which is incurred:
o	 As a direct result of armed conflict,
o	While engaged in extra hazardous service, or
o	Under conditions simulating war; or
o	which is caused by an instrumentality of war
•	The CI injured his knee during deployment to Afghanistan and thereafter, went through a prolonged period of medical diagnosis and treatment (including surgery), after which his condition unsuccessfully resolved.
•	The CI’s position demanded physical effort and fitness (he served as a physical and occupational therapist assistant) which was not supportable due to his physical condition.
•	The CI’s direct supervisor and peers submitted documentation to the PEB that refuted an original finding of FIT by the PEB and detailed how the CI’s physical condition impacted his duty performance.  All of this testimony connected any mood disorder the CI exhibited due to the unfortunate status the CI was in due to his physical impairment.  Nowhere is there any mention by anyone in the CI’s chain of command any event or series of events which the CI experienced while deployed, which could be classified as combat related and of a causative traumatic nature as described under VASRD 4.129.
•	The majority position is to award 4.129 in this case based on clinical reporting of combat exposure (psychotherapists in service as well as post separation).  As a matter of course, it is incumbent upon the rating agency to corroborate such testimony before awarding this designation.  There is no corroborating evidence other than from self-report by the CI.  In fact, there is evidence from the FPEB which directly refutes this assertion.
•	The CI was diagnosed with depression and anxiety, exhibiting features that were unfitting (according to the IPEB and FPEB) and ratable, under VASRD 4.130.
•	When asked via DD form 2697, block 15 (during the CI’s disability evaluation medical assessment process) “Do you have any conditions which currently limit your ability to work in your primary military specialty or require geographic or assignment limitations?” the CI responded with “knees pain; back pain”.  He did not mention any mental health condition.

•	The record of evidence is sparse with respect to mental health treatment records with the only evidence of treatment showing the CI undergoing mental health diagnosis and treatment well after returning from deployment, and while he was well into the disability evaluation process for his physical condition.  

•	The CI’s Post Deployment Health Assessment (04 August 2004) specifically asked the CI about experiencing anything “so frightening, horrible, or upsetting that in the past month you… had nightmares about it; tried hard not to think about it or avoid situations that remind you of it; were constantly on guard, watchful or easily startled; or felt numb or detached from others, activities or surroundings” – to which the CI answered NO to each of these conditions.  The same assessment asked if the CI had seen anyone wounded, killed or dead during the deployment to which the CI answered “yes – civilian.”  The CI also replied that he felt in great danger of being killed during the deployment.  Despite this, the CI denied any need for further help with stress, emotional, alcohol or family problems post deployment; and the CI denied being bothered by any mental health symptoms over the past two weeks indicative of depression.

It is my opinion this CI’s mental health disorder was the result of his physical demise in the face of losing his career with the Navy, falling out of place amongst his peers and otherwise becoming a disabled sailor from Naval service.  The CI was a West African immigrant, enlisting in the US Navy in December 2002 after arriving for residency in the United States in April of 2002.  It would be understandable that as an immigrant, the CI had a need to fit in with his peers and prove himself; both of which were unobtainable due to his physical condition.  The uncertainty of his future and loss of stature contributed greatly to his depressed and anxious mood and were mainly responsible for the development of his mental disorder.  There is no corroborating evidence in the record (and it would have to come from the CI’s deployment experience) to support application of VASRD 4.129 in this case.

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
       RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
      (b) PDBR ltr dtd 18 Nov 15 ICO XXXXXXXXXXXXXXXXXXXX  	 
      (c) PDBR ltr dtd 17 Nov 15 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 17 Nov 15 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (d).

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Temporary Disability Retired List (TDRL) for a period of six months with a 60 percent disability rating beginning date of discharge and a final disability rating of 20 percent with entitlement to disability separation pay upon removal from the TDRL.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)