RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02379
BRANCH OF SERVICE:  Coast Guard	BOARD DATE:  20150616
SEPARATION DATE:  20050120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Non-Rated Seaman Apprentice) medically separated for major depressive disorder (MDD).  The condition could not be adequately rehabilitated to meet the requirements of his non-rated duties.  He was placed on indefinite limited duty and eventually recommended for a Medical Evaluation Board (MEB).  The MEB forwarded MDD, as the sole submission, to the Physical Evaluation Board (PEB) for further consideration.  The Informal PEB adjudicated the MDD as unfit, rated 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The Board reviewed a lengthy contention submitted by the CI.  In it, the CI contended for his left knee, his shoulder (unspecified which side) as well as his unfitting mental health (MH) condition.

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:

IPEB – Dated 20040909	VA* (4+ Yr. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	MDD, Chronic Ongoing	9434	30%	20091004	
Other x 0 (Not In Scope)	Other x 5	
RATING:  10%	RATING: 50%	
*Derived from VA Rating Decision (VARD) dated 20091119 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board notes that the earliest VA evaluation was over 4 years after separation.  As elaborated above, the Board’s assessment must be derived from evidence that can be reasonably interpreted to reflect disability at the time of separation.  Therefore the evidence from the service treatment record (STR) was assigned the determinant probative value with respect to the Board’s recommendation.

Major Depressive Disorder.  The narrative summary (NARSUM) corroborated by the STR indicates that the CI did not have a history of MH issues until the development of multiple stressors in service.  These included significant orthopedic injuries requiring surgical interventions (2001 and 2003) with consequent career interruption and financial difficulties, divorce, and the deaths of his mother and a close friend in 2003.  The earliest STR entry for MH issues is a referral for alcohol problems in September 2003.  There is no evidence that alcohol abuse became a significant issue, but he was subsequently treated for depression.  Although he remained fit for duty, the above-mentioned stressors continued to mount; he became poorly compliant with treatment; and, was referred to a psychiatrist.  There is no STR evidence of psychotic or other acute psychiatric symptoms, serious disciplinary or legal issues, or psychiatric hospitalizations.

A psychiatric evaluation for the MEB was conducted on 20 February 2004 (11 months prior to separation), and elaborated a 2-year history of depression and anxiety linked to the above stressors.  The CI endorsed symptoms (among others) of sleep and appetite disturbance, difficulty with concentration, social withdrawal, loose suicidal ideation (no intent, plan, or attempts), and panic attacks.  The mental status examination (MSE) was positive for a “depressed and sad” mood and “flat” affect with “moderately impaired” concentration and attention (memory and other cognitive parameters intact); but, was otherwise normal, without active suicidal ideation or other acute features.  The Axis I diagnosis was MDD and the Global Assessment of Functioning (GAF) assignment was 47 (serious range of impairment).  The CI was “deemed unsuitable for continued military service,” but specific occupational limitations were not elaborated.

The NARSUM was conducted on 29 June 2004 (7 months prior to separation), and relied heavily on the above psychiatric evaluation for the MH condition.  Real time symptoms, acuity, and specific occupational and social limitations were not elaborated.  The CI was compliant with treatment at this time (corroborated by STR entries in the interval between the psychiatric and NARSUM evaluations), and there was no mention of drug or alcohol abuse.  He was prescribed two antidepressant medications (Celexa and Trazodone).  The recorded MSE was equivalent to the one described by the psychiatric consultant, a GAF assignment was not provided, and the MEB diagnosis (MDD) was taken from the psychiatric consult.  The commander’s statement (5 months prior to separation) documented that the CI “has performed exceptionally well in the duties assigned but due to his emotional disorder is not able to perform the functions of a duty watch-stander or be entrusted with non-supervised assignments.”

As noted above there is no temporally probative post-separation VA evidence.  The VA psychiatric Compensation and Pension evaluation over 4 years later (see rating comparison chart) documented erratic employment since separation and noted the lack of any MH treatment or medication at the time, although it suggested that it was indicated.  Similar symptoms to those documented in service were endorsed (perhaps less severe) and the GAF assignment was 50 (at the cusp of moderate/serious impairment).

The Board directed attention to its recommendations based on the above evidence; and, first considered whether the provisions of VASRD §4.129 for any “mental disorder that develops in service as a result of a highly stressful event” were applicable to this case (as mandated by DoD).  Although there was a host of medical and personal stressors that developed in service, members agreed that there was no single service-connected event which was logically consistent with the meaning and purpose of §4.129; thus, it was not appropriate for this case.  

The Board thus turned to deliberation of a fair rating recommendation for MDD at the time of separation.  The PEB specifically cited the VASRD §4.130 criteria for a 10% rating, “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.”  The acuity of symptoms reflected by the MEB psychiatric consultant (impaired concentration, panic attacks, marginal GAF, etc.) and the commander’s statement, however, strongly suggest that occupational limitations were significant and not “mild or transient”; thus, members agreed that the MH impairment was not fairly characterized by 10% criteria.  Deliberation thus turned to the most appropriate higher rating recommendation.  All members agreed that §4.130 criteria for a 100% rating were not met, nor were those for a 70%: “occupational and social impairment, with deficiencies in most areas” such as work, school, family relations, judgment, thinking, or mood” which reference symptoms such as obsessional rituals, illogical speech, near continuous panic or depression, spatial disorientation, neglect of hygiene, and inability to establish relationships.  Deliberation then ensued on consideration of a 50% recommendation (occupational and social impairment with reduced reliability and productivity) versus a 30% rating (occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks).  It was considered that the CI was able to function “exceptionally well” in his basic duties per his commander, that he manifested no severe abnormalities or critical cognitive deficits by MSE, and that his MH condition was stable with treatment at separation.  Members agreed, therefore, that his psychiatric impairment was better aligned with 30% criteria than with those for a 50% rating.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommends a 30% rating for MDD appropriately coded 9434.

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, the Board unanimously recommends a service disability rating of 30%, coded 9434 IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Major Depressive Disorder 	9434	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140513, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Commandant
United States Coast Guard	Mail Stop 7907
2703 Martin Luther King Jr. Ave SE
Washington, DC 20593-7907
Staff Symbol: CG-1
Phone: (202) 475-5000

						1850
Dear XXXXXXXXXX,	
I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2014-02379) and hereby modify the disability rating previously assigned to reflect a rating of 30% and re-characterization of your separation to permanent disability retirement. This decision will be effective as of the date of your prior medical separation.  Please allow up to ninety (90) days for the corrections to be made. 

Please note, if you received a lump-sum or other payment of back pay and allowances at separation, your disability retired pay may be reduced to take into account receipt of such lump-sum or other payment.  Please contact the Coast Guard Pay and Personnel Center at (800) 772-8724 for questions relating to retired pay matters. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at (703) 872-6628. 
	Sincerely,
2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs