RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX.	CASE:  PD-2014-03012
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20030331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Hospital Corpsman, medically separated for “major depressive disorder,” with a disability rating of 10%.  

CI CONTENTION:  The CI requested consideration of 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 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 PEB - 20032201	VARD - 20040505	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Depression	9433-9434	10%	20040126	
Post-Traumatic Stress Disorder	EPTS	Post-Traumatic Stress Disorder	9411	NSC	20040126	
Borderline Personality Traits not Constituting a Personality Disorder	Cat IV	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s MDD symptoms occurred after a breakup with her fiancé in 2001.  She developed a depressed mood, crying spells, irritability and lack of pleasure.  He also had other symptoms of MDD.  The CI was treated with talk therapy and psychotropic medications and reported a good response.  She later discontinued her medications and her symptoms returned with greater severity.  Despite treatment, the mental health condition could not be adequately rehabilitated to meet the requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded the following condition, “post-traumatic stress disorder chronic (PTSD) and major depressive disorder (MDD), single episode, moderate, in partial remission” for PEB adjudication.  

At the MEB NARSUM, 3 October 2002, approximately 6 months before separation, the CI reported a history of childhood sexual abuse and a rape at the age of 18.  She noted that she had nightmares of her abuse and other symptoms consistent with PTSD from the abuse.  She also continued to have symptoms of depression.  Mental status examination (MSE) documented a sad mood and a tearful affect.  All other aspects of the examination were unremarkable.  The diagnoses of PTSD secondary to sexual assault, existed prior to entry, and MDD, single episode, moderate, in partial remission were recorded.  The examiner also diagnosed borderline personality traits.

At the VA Compensation and Pension (C&P) examination in January 2004, performed 9 months after separation, the CI reported she had suffered “depression and PTSD when she went through some experiences while in the military.”  She reported that she had felt harassed by her supervisor who would often yell at her.  She cited another incident at work and reported she was made to feel uncomfortable at work.  The CI indicated she had continued her medication but was unsure of the name of it.  It was noted that the CI had a history of two psychiatric hospitalizations in the month of June 2003, 2 months after separation, and that she had no hospitalizations prior to separation, and none in the past 9 months.  The examiner noted that the CI was in MH treatment and was taking three different types of mood stabilizing medication, which the CI reported were helpful.  She was not employed.  The MSE was unremarkable with the exception of anxious mood.  The single diagnosis of MDD, chronic, moderate was recorded.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of MDD, coded 9434 at 10%, with the notation that the condition did not result from a combat related injury.  Likewise, the VA, granted 10% disability rating under the same code.  

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.  A traumatic stressor was not documented in the treatment record.  All Board members agreed the provisions of §4.129 were not applicable.   The Board reviewed the evidence and proceeded to rate under VARSD §4130.  The NARSUM recorded absence of psychiatric hospitalizations and a relatively normal MSE.  It was noted that her condition was “so severe that it significantly impairs her ability to render any further useful military service.”  However, the examiner did not elaborate on what constituted the severity of her condition, but had opined that her depression was in partial remission.  

The non-medical assessment (NMA) dated 26 November 2002 noted that the CI had regular participation in MH treatment, but, noted she had a recent suicidal gesture that resulted in hospitalization.  Evidence of hospitalization prior to separation was absent.  The Board noted that in the few weeks before separation, the CI was transported to the emergency room for a possible suicide attempt.  She was not admitted to the hospital.  The CI denied suicide ideation, or attempt, and noted that she had been upset over her situation.  

The Board also considered the two hospitalizations 2 months after separation and the C&P examination.  All Board members agreed, the CI’s condition at separation had not completely stabilized; however, at the time of the C&P examination, her condition had stabilized, and she noted her medications were helpful.  The record demonstrated that after the CI’s June 2003 hospitalizations, she had no additional hospitalizations for approximately 12 months.  The Board also noted the transient nature of her condition, and the temporal relationship of her symptoms to life stressors.  Board members concluded, at the time of separation, the CI’s condition was best reflected in the 10% disability rating for “occupational and social impairment due to transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress.”  After due deliberation, and 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 major depressive disorder condition. 

PTSD.  The PEB assigned no rating for the PTSD condition, citing “EPTS [existed prior to service].”  The VA also assigned no rating for the PTSD condition, citing the condition was not service connected.  The Board found no evidence to indicate this was not correct.  The Board next considered whether or not there was evidence of service aggravation.  A presumption of service aggravation may only be overcome by a preponderance of competent medical evidence and accepted medical principles that the natural progression of a pre-existing condition was clearly unaltered by any consequence of military service.  Service treatment entry dated 3 April 1998 noted that the CI had received MH treatment for PTSD related to childhood sexual abuse.  According to the NARSUM, the CI had reported an extensive history of childhood abuse that existed prior to military service.  Her experiences manifested in the development of significant PTSD symptoms including nightmares of her abuse, diminished participation in social activities, hypervigilance and a pervasive distrust of men.  The NARSUM noted that the CI had participated in therapy after the sexual assault prior to service, but noted that she continued to have symptoms suggestive of PTSD.  The examiner indicated the condition existed prior to service, but made no remarks regarding service aggravation.  At the VA C&P examination, the CI reported childhood abuse history and noted that she felt she had been verbally abused while in the service.  The examiner opined that the CI’s condition did not fulfill the diagnostic criteria for PTSD.  The STR noted that the CI reported interpersonal issues at work; however, the NMA noted that she took pride in her work and was motivated to perform well.

The Board considered the evidence in its totality and was unable to find any justification to support a change in the PEB’s decision in this matter.  After due deliberation, considering all of the evidence the Board concluded the EPTS PTSD condition was not permanently aggravated by service beyond the natural progression of the condition and therefore recommends no change in the PEB’s adjudication.

Contended PEB Conditions: Borderline Personality Traits not Constituting a Personality Disorder. 
The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the major depressive disorder condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the PTSD condition, the Board unanimously recommends no change from the PEB determination as EPTS.  In the matter of the contended borderline personality traits condition, the Board unanimously recommends no change from the PEB determination as not a physical disability and therefore, not ratable.

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 20140512, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 6 Jul 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						  	(Manpower & Reserve Affairs)