RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-03078
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Light Wheeled Mechanic, medically separated for “major depressive disorder,” with a disability rating of 10%.

CI CONTENTION:  The applicant requests the board 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 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 - 20080729	VARD - 20090226	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Adjustment Disorder	9440	10%	20080915	
			PTSD	9411	NSC	20080915	
Intervertebral/Lumbosacral Disc Degeneration	Not Unfitting	Lumbar DDD	5010-5242	10%	20081024	
Joint Pain, Shoulder	Not Unfitting	Left Shoulder Strain	5201	0%	20081024	
		Right Shoulder Strain	5201	0%	20081024	
Patellofemoral Dysfunction	Unfitting	Left Knee Patellofemoral Synd	5260-5024	10%	20081024	
		Left Knee Patellofemoral Synd	5260-5024	10%	20081024	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Major Depressive Disorder (MDD).  The psychiatric narrative summary (NARSUM) was conducted in March 2008, 8 months prior to separation.  The examiner documented that in 2002 the CI had symptoms of depression with suicidal ideations and partner relational problems (pending divorce).  He was treated intermittently with antidepressants medications with noted benefit.  He deployed in 2003 without medication, and had no demonstrated mental health (MH) issues.  During his second deployment to Iraq in 2007, he sought MH care due to issues with his NCO.  He reported homicidal thoughts towards the NCO and had some suicidal ideations.  At some point during the second deployment he reportedly was medically evacuated due to anxiety and depression, and problems with sleep and concentration.  At the time of the NARSUM, the CI reported decreased motivation, nightmares related to childhood trauma, hypervigilance related to combat experience, restless sleep and an erratic appetite.  He did not like crowds.  He denied a history of panic attacks.  The mental status examination (MSE) was unremarkable with the exception of depressed mood and affect.  The examiner noted that the CI had periods of “erratic” treatment with medications; however, he had not responded to medications when under “situational stressors.”  The diagnosis of MDD, chronic, moderate was assessed.

The VA Compensation and Pension (C&P) mental exam was accomplished 2 months prior to separation.  The CI reported his medication and counseling were effective.  He noted that he was separating from his wife and that it was not related to his MH problems.  He noted he had lost no days of work and that he went fishing every other weekend.  The MSE was unremarkable.  The diagnosis of adjustment disorder with mixed anxiety and depressed mood was recorded.  The examiner documented no significant issues with sleep, panic attacks, or memory.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of MDD at 10% coded 9434 (major depressive disorder) for symptoms controlled by continuous medication.  All Board members first agreed that the preponderance of evidence did not support the application of §4.129.  The Board next considered the rating recommendation.  The higher rating of 30% requires evidence of “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” due to  such symptoms as:  depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events.  The NARSUM examiner noted that the CI’s condition was strongly influenced by situational stressors, and was likely to improve when he no longer experienced stressful work and social situations.  His prognosis was considered fair if he continued in treatment.  The VA examiner, 2 months prior to separation, noted the CI reported good benefits from treatment.  MDD was not assessed; the diagnosis of an adjustment disorder was made.  The commander’s statement did not implicate a specific condition, but noted that the CI was a model soldier, “above average.”  All Board members agreed the CI’s condition at the time of separation, did not support the higher 30% disability rating and that his level of impairment was better described as occupational and social impairment due to mild or transient decrease in work efficiency and inability 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), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the MDD condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that intervertebral/lumbosacral disc degeneration, shoulder joint pain, and patellofemoral dysfunction were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  These conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are 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 contended intervertebral/lumbosacral disc degeneration, shoulder joint pain, and patellofemoral dysfunction conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140425, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160007957 (PD201403078)

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 1 O, 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
( ) OVA