RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02638
BRANCH OF SERVICE: Army 	SEPARATION DATE:  20051124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Helicopter Repairer) medically separated for major depressive disorder (MDD).  The MDD could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent L2/S3 profile and referred for a Medical Evaluation Board (MEB).  The “major depressive disorder, recurrent, severe, w/o psychotic features,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “major depressive disorder, recurrent” as unfitting, rated 10%, citing application of AR 635-40.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI made no contention.  The applicant’s complete submission is at Exhibit A.  

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:  

IPEB - Dated 20050817	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depressive Disorder	9434	30%	STRs	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 10	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20060517 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:   

MAJOR DEPRESSVIE DISORDER.  The narrative summary (NARSUM) notes the CI’s depressive symptoms emerged out of marital problems, and other family issues.  The CI reported that his depressed mood began in January 2003, which he related to being separated from his family for the majority of his career.  He worried that he would lose his family and became significantly depressed and was having difficulties with sleep, appetite, energy, concentration, and feelings of guilt regarding his family.  He had not sought treatment to this point.  He then deployed to Iraq.  In November 2003 while on R&R leave from Iraq, he was given a one month trial of Paxil, and reported no benefit.  His depression continued and after his re-deployment in March 2004, he learned of his wife’s infidelity.  The couple divorced in September 2004, and the CI presented to mental health for the first time.  At the time of presentation (Sept. ’04) he endorsed a history of previous homicidal ideations toward his wife’s lover, which had since resolved, and he endorsed some feelings of anxiety related to family and financial issues.  The CI also reported frequent suicidal ideation with thoughts of driving off the road; however, indicated he had no intent because of his children.  There were multiple stressors that included continued conflict with ex-wife, custody issues, legal issues with being accused of adultery, financial issues, and stress of being harassed and threatened by the husband of a woman he had dated.  The CI underwent multiple medication trials with different anti-depressant agents (Prozac, Zoloft, Wellbutrin, Lexapro, and Trazodone for sleep) without significant benefit.  He continues to have depressive symptoms which included insomnia.  He reportedly stated that in April 2005, he did not go to work for a week; he lay on the floor all day.  He had frequent thoughts of suicide, and also was having intermittent homicidal thoughts towards his ex-wife and her lover.  At the NARSUM, 4 months before separation, the CI noted that his responsibilities at work had been slowly decreased since November 2004, noting that he went from working on aircraft to doing paperwork in an office to primarily “just sitting around” due to his increasing difficulty accomplishing tasks reliably.  Mental status examination documented psychomotor slowing, monotone speech, that was of normal rate.   The CI reported his mood as “depressed”.  His affect was constricted, and there was no evidence of psychosis; however, he reportedly expressed frequent, intermittent suicidal thought of crashing his car and he also reported occasional homicidal thoughts towards his ex-wife and boyfriend.  He denied suicidal or homicidal intent.  Judgment was recorded as fair.  The diagnosis of major depressive disorder, recurrent, severe was recorded and a global assessment of functioning (GAF) score of 50 (serious symptoms or impairment) was assessed.  The examiner opined, “Given his multiple stressors, inadequate response of his depressive symptoms to treatment, thus far and significant feelings of hopelessness, he remains at moderate to high risk for suicide.”   

the commander’s statement dated 2 months before the NARSUM, stated, “SM has been moved from his duty position as an advanced attack helicopter repairer because he cannot perform his duties of climbing, carrying, lifting, or standing for long periods of time and from carrying a weapon which are required for performance of the 15R job tasks.”  The commander further noted that he is currently working in company headquarters section where he cannot perform certain duties because of his physical limitations; however, his work has been adequate.

The CI was non-attendant to the scheduled VA Compensation and Pension (C&P) exam.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10% for “mild social industrial impairment IAW AR 635-40, Appendix B-107, Paragraph e.”, coded 9434, (major depression).  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.  All Board members agreed the provisions of §4.129 were not applicable.  The VA used the service treatment record and granted a 30% disability rating based on the NARSUM recording of depressed mood, sleep impairment, depressive symptoms, and “history of suicidal ideations”.  The Board proceeded to rate under §4.130 and compared the NARSUM opinion of the CI’s employability and work function, and the commander’s statement of duty performance.  Deliberations focused on the 30% versus 10% rating levels.  The 30% rating requires evidence of “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”.  The NARSUM examiner noted that much of his impairment related to psychosocial stressors involving conflict with ex-wife, finances, custody issues and other legal issues related to relationships.  These issues culminated in frequent thoughts of suicide (SI) and homicide (HI) without reported intent.  The NARSUM also documented the CI’s report of having repeated decrease in work responsibility due to his mental health problem; however, there is no mental health issue mentioned in the commander’s statement that states he is performing adequately.  There was no mention in the commander’s statement of the CI failure to present to work, or that he had difficulty with concentrating, or staying awake. The Board also considered the absence of documented visits to the emergency room or psychiatric hospitalization, and acknowledged that although the CI reported frequent SI and HI, there was no evidence in the service treatment record, including the NARSUM, that he was ever placed on a suicide watch or buddy watch.  The Board also noted the NARSUM’s examiner’s statement that the CI “remains at moderate to high risk for suicide”, and was curious about this opinion since there were no recorded suicidal gestures or attempts, and no apparent psychiatric emergencies.  Furthermore, The NARSUM examiner noted in his MSE that he was expressing SI and HI, but did not refer him for safety check.  The Board also considered the non-commissioned officer evaluation dated April 2005 for the evaluation period of September 2003-August 2004.  This evaluation documented that the CI was “among the best” in regards to overall potential for promotion, and “is mentally tough”.  The Board noted that this timeframe covers the deployment, and the months just prior to his initial presentation to mental health where he reported he had previous symptoms of depression and homicidal thoughts.  After careful deliberation, Board members concluded his condition at the time of separation most closely reflected the 10% level of disability for “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.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), and the application of §4.130, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the major depressive disorder 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.   As discussed above, PEB reliance on AR 635-40 for rating MDD was operant in this case and the condition was adjudicated independently of that instruction by the Board.  In the matter of the Major 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 20140601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
SAMR-RB						

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 XXXXXXXXXX, AR20160003426 (PD201402638)

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