RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX 	CASE:  PD-2014-03216
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20010928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-1 (Public Affairs Officer) medically separated for major depressive disorder, rated at 10%.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  His 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 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 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 20010719	VA* - ~9 Months Post-Separation 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder…	9434	10%	Major Depressive Disorder	9434	NSC	20020530	
Ineffective Coping Skills and Demands of Military Duty	Cat III	No VA Placement	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20021007 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Major Depressive Disorder.   The service treatment record contained two examinations with the subject matter of “Medical Evaluation Board,” one dated 21 June 2001 and the other dated 18 July 2001.  Both were authored by the same examiner and the content of each was identical.  The psychiatric narrative summaries (NARSUM), 2-3 months prior to separation, noted the CI was referred to mental health (MH) by chaplain services and was first seen in the MH clinic in June 2001.  During his initial MH evaluation, he reported a significant level of depression after joining the Air Force.  He endorsed increasing suicidal ideation (SI), decreased sleep and interest, decreased energy, concentration and appetite, and no change in libido.  He was assessed with MDD, single episode, severe without psychosis.  Hospitalization was not considered; however, he was placed on an S4 profile, and agreed to a “no self-harm” contract.  MH entry a week later documented a normal mood, but SI continued; however, he was future-oriented, noting he felt things would improve (“light at the end of the tunnel”) once he separated from the Service.  The NARSUM documented a history of daily suicidal ideation for 5-6 months; the CI reportedly stated he felt he had no way out of his situation other than to kill himself.  He denied owning a firearm, and stated the only reason he had not killed himself was out of “fear of the unknown.”  The CI related that he felt lied to by his recruiter.  He was told that being in the Service would be like a regular “9-5 job.”  He reportedly stated that he felt stuck in a career field that he did not like for at least another year.  He had completed officer training and was placed in the original service position that he did not want.  He became disillusioned and distressed, and felt overburdened at his 12-hour a day job that placed a great deal of responsibility on him and some contention.  He and his wife of 10 years had no children, and he noted that his marriage was “not as good as it used to be.”  He attributed his marital strife to not having enough time to spend with her due to his long work hours.  The examiner documented the CI was seen twice in the MH clinic in follow-up since the initial appointment and has maintained that the service is the only source of his depression and suicidal ideation. Service treatment records demonstrated an additional three visits prior to last NARSUM.  Both exams noted the absence of use of psychotropic medications.  Mental status examination (MSE) recorded a ‘guarded’ affect, and the CI’s report of a depressed mood.  There was no disturbance in thought processes, perceptions, hallucinations, or cognition.  Suicidal ideation was noted as present “with questionable plan and intent.”  The diagnoses were recorded as 1) MDD, single episode, severe without psychotic features, with severe impairment for military service and “definite” degree of impairment for civilian social and industrial adaptability, and 2) Occupational problems with severe impairment for military service and mild degree of impairment for civilian social and industrial adaptability.  The examiner documented the CI’s stressors related to “demands of military duty and ineffective coping skills.”  A Global Assessment of Functioning (GAF) score of 50 (connoting moderate to borderline serious impairment) was recorded, and the examiner opined that if the CI remained in the service he will likely consider suicide the only option to his situation.

At the time of the C&P exam, 8 months post separation, the CI reported he and wife had divorced and that he is planning on re-marrying.  He reported good energy, good concentration, and absence of suicidal ideation.  He noted that he felt his depression was due to the stress he experienced in officer training school and his marital problems.  His MSE was completely normal and the examiner recorded on Axis I: “No mental illness”.  A GAF of 85 with absent or minimal symptoms was recorded on Axis V.   

The Board directed its attention to the rating recommendation based on the evidence just described.  As recorded above, the PEB rated the condition of MDD at 30%, coded 9434 with a 20% deduction for aggravating/contributing factors, thus, a final 10% rating.  The VA did not service connect the condition.  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 Board next considered the rating deduction. The PEB noted the condition of “ineffective coping skills and maladaptive military adjustment as Category III, “Conditions that are not separately unfitting and not compensable or ratable.”  The Board considered the PEB’s deduction was related to the Category III condition.  The Board agreed the Category III condition is not compensable; however, all members agreed that the PEB’s deduction could not be upheld for application to the Board’s recommendation.  The Board next proceeded with the rating recommendation.  The Board undertook a careful review of the service Treatment Records and was unable to find any documentation of symptoms other than suicidal ideation, after the initial MH visit in June 2001.  In the additional five visits, the examiner documented that the CI was future-oriented, which is inconsistent with threats of suicide, and although, suicidal ideation was reported there were no indications of a plan nor intent.  At the 26 June visit, the CI noted that he was oriented towards the future “as long as there is hope that he will be released from the military”.  The Board considered the C&P exam had significant probative value.  The C&P exam, months post-separation, documented that this condition was not present, nor were there any MH issues identified.  Since his release he had no depressive symptoms or suicidal thoughts.  A GAF of 85 (absent or minimal symptoms) was recorded.  Furthermore, there was no indication that he was receiving any MH treatment, and the record demonstrated that he never used any medication to treat his reported symptoms.  He had just started a job at the Air Force base and noted that he liked his job very much.  Although the CI reported suicidal ideation without a plan while active duty, there were no documented attempts, no indication that he had ever considered a lethal plan, and no indication that he was ever placed on suicidal watch, or that he presented to the emergency room for his suicidal thinking.  Suicidality, although a serious complaint, in the absence of other symptoms and in the presence of planning a future, and in response to a specific stressor, suggests the symptom was transient and decreased work efficiency only during periods of significant stress.  This description is consistent with the 10% disability level.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a 10% rating (no deduction) for the MDD under code 9434.  

BOARD FINDINGS: In the matter of the major depressive disorder, the Board recommends a disability rating of 10%, coded 9434, IAW VASRD §4.130 and exclusive of any deduction.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends no change in the CI’s disability and separation determination, but a modification in the basis for rating by excluding the deduction for the Category III condition as applied by the PEB. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140701, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03216.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your disability findings without modification of the final rating or re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Attachments:
1.  Directive 
2.  Record of Proceedings 

cc: SAF/MRBR