RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX                                                                         CASE:  PD-2014-02947
BRANCH OF SERVICE:  Army                                                               SEPARATION DATE:  20040924

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Cannon Crew Member, medically separated for “major depressive disorder, with psychotic features” with a disability rating of 10%. 

CI CONTENTION:   “Please consider all conditions.” The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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 PEB - 20040727	VARD - 20050913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder (MDD) w/Psychotic Features …	9434	10%	PTSD w/MDD and Psychotic Features	9434-9411	70%	20060120	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

MDD.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s first record in evidence for a mental health (MH) condition is an emergency room note dated 8 January 2004, 8 months prior to separation, when he was evaluated late at night for thoughts of hurting himself or others.  He had told a friend that he was thinking of jumping off of a bridge.  He reported that he had been depressed since childhood to include throughout high school, he did not like the military, which he had joined for the educational benefits, and was more depressed than normal recently.  It was noted that he was scheduled to go to the NTC (National Training Center).  He also reported fighting a lot.  He was thought to have anti-social personality traits and to be very manipulative.  He was transferred the next morning to a local MH hospital for inpatient treatment where he was a patient from 9-16 January 2004.  Those hospital records are not in evidence.  He was then transferred back to the local military hospital for further care and initiation of an MEB.  

At the MEB examination on 20 January 2004, 8 months prior to separation, the CI reported that he was “chronically depressed…my mind won’t continue to hold up and I’m very unstable to which point I don’t know.”

The MEB NARSUM was accomplished 15 January 2004 while the CI was still hospitalized.  He reported auditory and visual hallucinations, poor sleep, loss of pleasure in activities normally enjoyable, a feeling of helplessness, decreased energy, decreased concentration and appetite, isolation, and vague homicidal and suicidal ideation.  He reported childhood physical abuse and also a history of being expelled twice (fighting and striking matches).  He endorsed a history of Tourette’s syndrome (involuntary physical tics and vocal outbursts [frequently profane]) and attention deficit and hyperactivity disorder.  The mental status examination (MSE) was positive for suicidal and homicidal ideation without a plan, auditory hallucinations of whispered voices which he could not identify, visual hallucinations of “humanoids” in his peripheral vision, mild psychomotor retardation, and a blunt affect.  Insight and judgment were limited.  He responded well to treatment, but remained symptomatic while hospitalized.  He was diagnosed with MDD, single episode, with psychotic features.  He also endorsed post-traumatic stress disorder (PTSD) traits such as increased startle, flashbacks of smells, and hypervigilance.  An MSE on 4 February 2004 was essentially normal and cleared the CI to participate in the MEB process.  It noted that his behavior was normal and that he was fully alert and oriented.  He had an unremarkable mood, clear thinking, normal thought content, and good memory.  It also noted that he was responsible for his actions.  Knee pain was noted and duty modifications were recommended pending return to duty.  He was recommended for another job as he could no longer function in his military occupational specialty (MOS).  The Board noted that the MOS 13B10 (cannon crew member) requires an S1 profile.  While in the MEB process, the CI tested positive for cocaine on a random urinalysis on 17 February 2004.  He admitted to use on 14-15 February 2004.  He was fined and reduced in rank to E-1.  The commander’s statement, dated 2 June 2004, noted the MH condition and substance abuse.  The commander opined that the CI was mentally incapable of performing his duties due to the history of a suicide attempt.  A general discharge was recommended.  The commander also noted that the CI was undergoing an MEB evaluation for a P3 profile of his knee.  The CI did indicate a knee problem (not defined) on the MEB DD Form 2807.  However, the physical examination (DD Form 2808) was normal, there is no mention of a knee problem in the MEB, and it was not profiled.  

The 27 July 2004 PEB, 2 months prior to separation, recorded that the CI was performing light duty and that his impairment was better described as mild rather than definite.  The impairment was not thought to be combat-related and the blocks on the DA Form 199 confirming this, typically referred to as 10.a and 10.c, were not checked.  The DD Form 214 dated 24 September 2004 showed that the CI was deployed to Kuwait from 10 June 2003 to 15 July 2003.  

During the VA Compensation and Pension (C&P) joint examination, 22 August 2005, the CI reported that he could not work due to injury to his back, feet, and left knee.  The general VA C&P examination was performed 4 days later on 26 August 2005, 11 months after separation.  The CI reported a history of PTSD, manic depressive disorder, and psychosis with schizoaffective type disorder.  He was followed by psychiatry.  He reported no psychiatric problems prior to combat in Iraq.  He denied suicidal or homicidal ideation, but endorsed nightmares, smells of burned bodies, and avoidance behavior.  He was frequently withdrawn.  He was currently a student.  The MH C&P was accomplished on 8 January 2006, 16 months after separation.  It noted that the CI had been seen in behavioral health for an intake examination on 1 June 2005, 9 months after separation.  He reported that he had had been depressed since August 2003.  He endorsed hypervigilance, hallucinations, and periods when he was unaware of what was going on around him.  He reported that he served in Kuwait and Iraq from January to July 2003.  As noted, this is not consistent with military records.  He reported frequent combat patrols and seeing dead Iraqis often.  He reported that he had been burned from a bomb dropped 300 yards from his position, that he had frequently been in hand-to-hand combat, and that he had 23 confirmed kills and 19 unconfirmed kills.  The Board noted that the CI was issued an Army Commendation Medal on 11 May 2003 for actions from 20 March 2003 to 14 April 2003.  No mention was found for a “V” device.  This award was not listed on either the DD Form 214 or on the enlisted record brief.  The CI also reported hallucinations beginning in August 2003 and that he had seen MH for five sessions over the next 1-2 months.  This history is not supported by the STR.  The record does show that the CI was seen for right knee pain and depression on 22 September 2003, but no additional visits are in evidence.  The CI reported that he was not allowed to continue his MH treatment by his sergeant due to the ramp up for redeployment to Iraq.  A personality inventory was completed, but not valid due to elevated scores.  

The VA C&P examination to review the PTSD condition was dated 9 May 2008, almost 44 months after separation.  The CI reported that he was living with friends and taking a pottery class.  He reported recurrent dreams of being dismembered from “incoming” during a building raid in Baghdad and that he was in Iraq from March to July 2003.  It was noted that the history reported by the CI conflicted with the records and the DD-214.  It was also noted that the prior MH C&P documented hand-to-hand combat with confirmed kills which were not mentioned in the current interview.  He reported injuries in combat.  However, he did not have a Purple Heart and the DD Form 214 showed that he was in Kuwait from 10 June 2003 to 15 July 2003.  The CI reported that the DD Form 214 was erroneous.  He also reported that the Article 15 for cocaine use was due to him being forced to sign a container of urine which belonged to someone else.  The Board noted that the an investigation dated 10 March 2004 documented that the CI admitted to the use of cocaine after he had been advised of and waived his legal rights (to avoid self-incrimination).  He was noted to be a very poor historian.  His affect was flat and he was very defensive and not forthcoming other than responding to direct questions.  It was also noted that his thought processes were extremely circumstantial and that the some of the description of his military experiences had an unrealistic quality about them.  It also was noted that his history conflicted with the DD-214, but if his history was accurate, then he did still meet the criteria for PTSD.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the MDD with psychotic features condition 10%, coded 9434, (MDD), citing criteria of AR 635-40, Appendix B-107.  The VA originally rated the MH condition as not service-connected but later rated 70% twice, coded analogously as 9434-9411 (MDD–PSTD) based on C&P examinations conducted 23 February 2006 and reviewed 11 July 2008, 16 months and nearly 44 months post-separation, respectively.  The Board noted the information in these two examinations is inconsistent with the STR and the examinations are inconsistent with each other.  The probative value of these two examinations is therefore reduced and neither is used for rating purposes. 

The Board next considered the application of VASRD §4.129 (mental disorders due to traumatic stress).  The CI was noted to have PTSD traits by the PEB, but on the DA Form 199 both indicators were negative.  The DD Form 214 does not support the history reported by the CI to the VA which was used to support the VA PTSD diagnosis.  The evidence does not support the application of VASRD §4.129.  The Board then considered the rating IAW VASRD §4.130 (mental disorders).  The criteria for a 10% rating include “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, or; symptoms controlled by continuous medication.”  The criteria for a higher 30% rating are “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 there was only one episode of an inability to perform his duties and that resulted in the diagnosis and admission for the suicide attempt.  However, this was in the context of an imminent deployment to the NTC in preparation for redeployment to Iraq.  The CI was identified for an MEB during the hospitalization.  Less than 3 weeks later, he had a normal MSE.  The PEB noted that he was performing light duty.  The commander also noted that he was performing light duty and that his behavior, cocaine abuse, was inconsistent with the values of the US Army.  A general discharge was recommended.  The VA general C&P 11 months after separation noted that the CI was not working due to orthopedic issues.  The initial VA MH evaluation was accomplished 16 months after separation and inconsistent with the historical record.  It is not probative for rating purposes 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 MDD condition.  

Contended PEB Condition: Musculoskeletal Pains.  The PEB only considered the MH condition in its determination.  The MEB noted that there were multiple musculoskeletal pains which were medically acceptable; these were not individually cited.  However, the NARSUM did note that there was a past history of bilateral knee pain, neck pain, and the ability to dislocate both shoulders.  No current symptoms were recorded and the physical examination was normal.  None were profiled.  The commander noted that the CI was on a profile for his knee for which he was undergoing an MEB.  However, the MEB only considered the MH condition.  The record shows that the CI was seen once for the left knee and once for the right.  Both visits were just over 1 year prior to separation.  The diagnosis of multiple musculoskeletal complaints was reviewed and considered by the Board.  There was no performance-based evidence from the record that any musculoskeletal condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend the addition of an unfitting musculoskeletal condition and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended “musculoskeletal pains” condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  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 20140521, 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

17 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017025 (PD201402947)

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