RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02931
BRANCH OF SERVICE:  coast guard	BOARD DATE:  20141023
SEPARATION DATE:  20050502

SUMMARY OF CASE:  The available evidence of record reflects that this covered individual (CI) was an active duty SA/E-2 medically separated for dysthymic disorder.  The dysthymic disorder condition could not be adequately rehabilitated to meet the requirements of his rating or physical fitness standards and he was referred for a Medical Evaluation Board (MEB).  “Dysthymic Disorder” and “Borderline Personality Features” were forwarded to the Physical Evaluation Board (PEB) IAW COMDTINST M1850.2D.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated the dysthymic disorder condition as unfitting, rated 10%.  The CI made no appeals and was medically 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 dysthymic disorder condition is addressed below and, no additional conditions are 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 IPEB – Dated 20050202	VA - (12 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dysthymic Disorder	9433	10%	Dysthymic Disorder (Claimed as Manic Depression)	9433	NSC	20060510	
Borderline Personality Features	Not Compensable					
Other x 0 (Not in Scope)	Other x 0	
Rating:  10%	Combined:  NSC	
Derived from VA Rating Decision (VARD) dated 20060710.

ANALYSIS SUMMARY:

Mood Condition.  A treatment note by a civilian psychiatrist dated 22 April 2003 documents a diagnosis of and treatment for bipolar II disorder.  A psychiatric evaluation dated 29 January 2004 by the same psychiatrist noted a 2-year history of paranoia and racing thoughts.  At the time of the evaluation the CI reported anxiety, confusing thoughts, being on guard, insomnia and not being able to relax.  He denied delusions and hallucinations.  He endorsed some feelings of worthlessness, depression, hopelessness and guilt.  He also endorsed spending more time by alone and being uncomfortable in close spaces with three to four individuals for an extended time.  The mental status examination (MSE) was significant for slight decreased in motor movement, a somewhat blunted affect and somewhat hindered judgment.  The examiner rendered a diagnosis of depression, not otherwise specified (NOS) and rule-out bipolar disorder and psychotic disorder NOS was noted.  Alcohol dependence in early remission was recorded.  A Global Assessment of Functioning (GAF) score of 55 (moderate) was assigned.  A treatment note dated 10 February 2004 noted that the CI’s mother confirmed a history of a cycling mood disorder.  The examiner continued the diagnosis of bipolar II disorder.  The CI agreed to a trial of Depakote with continuation of pharmacologic and weekly talk therapies.  The CI continued pharmacologic and weekly talk therapy with the civilian provider and was also referred back to the Coast Guard for further evaluation.

At the Coast Guard psychiatric second opinion dated 6 July 2004, the psychologist noted a history of chronic low mood and significant doubt about his own abilities and role in his environment.  She noted that the CI’s irritable mood swings dated back to high school with a history of substance abuse. The examiner noted there was no current evidence of alcohol abuse.  The MSE was not on file, but there was reference to slight psychomotor retardation.  The examiner diagnosed dysthymic disorder and borderline personality features.  The examiner noted the CI’s prognosis was fairly good with continued psychotherapy and medication management.

The narrative summary dated 6 January 2005 noted the CI continued to experience consistently poor mood and work performance despite treatment.  The examiner noted the CI had been compliant with treatment for 5 months.  The opinion of the Board was the diagnoses of dysthymic disorder and borderline personality features were correct and compromised the CI’s ability to carry out his duties in the Coast Guard.

At the VA Compensation and Pension examine dated 10 May 2006 (12 months after separation), the CI gives a history of mood dysregulation, unstable relationships, impulsive behaviors, marked reactivity and chronic feelings of intense anger and emptiness dating back to his junior and senior years in high school.  At the time of the examination, the CI reported excessive alcohol and pain medication use.  He reported an inability to maintain employment due to attitude and emotional instability, extreme impulsivity, panic attacks and depression.  He stated that his depression did not last more than a few hours to days, but that his mood fluctuated hour to hour.  He endorsed passive suicidal ideation without intent and plan and cutting for purging of emotions.  He described his three to four times per week panic attacks as tachycardia, palpitations and shortness of breath, diaphoresis, lightheadedness, dizziness, nausea and vomiting.  The MSE was significant for poor concentration with loss of track of conversations, depressed with anxious mood and affect, poor judgment and limited insight.  The examiner rendered diagnoses of polysubstance abuse, anxiety disorder NOS; rule out panic disorder; dysthymia; and borderline personality disorder.  A GAF score of 50 (moderate) was assessed.  The examiner opined that he did meet criteria for bipolar disorder, but that a clear diagnosis of any mood or anxiety disorder could not be made due to substance abuse.  The VA did not service-connect any mental disorder diagnosis.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated the dysthymic disorder as unfitting with a disability rating of 10%, coded 9433, dysthymic disorder.  The PEB did not adjudicate the borderline personality features because it does not constitute a physical disability and is therefore not compensable.  The VA did not service-connect any mental disorder diagnosis.  There was no evidence of a traumatic event, therefore the Board determined that VASRD § 4.129, Mental disorders due to traumatic stress was not applicable in this case.  The Board deliberated whether there was evidence in support of a higher than 10% disability rating.  The 30% rating requires 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).  The Board noted that despite medication and talk therapy, the CI continued to demonstrate “consistently poor mood and work performance.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the dysthymic 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.  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 dysthymic disorder condition, the Board unanimously recommends a disability rating of 30%, coded 9433 IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends the CI’s prior determination be modified as follows; and, the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation: 
 
UNFITTING CONDITION	VASRD CODE	RATING	
Dysthymic Disorder	9433	30%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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-2014-02931) 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,

	XXXXXXXXXXXXXXXXXXXX
	Rear Admiral, U. S. Coast Guard
	Assistant Commandant for Human Resources

2 Enclosures

Copy:
CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs