RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03381
BRANCH OF SERVICE:  Air force	BOARD DATE:  20141210
SEPARATION DATE:  20060117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Tactical Aircraft Maintenance) medically separated for a depression, not otherwise specified (NOS).  The mental health (MH) condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued an S4 profile and referred for a Medical Evaluation Board (MEB).  Depression was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “depressive disorder, NOS” as unfitting, rated 10%, referencing application of Department of Defense and VA Schedule for Rating Disabilities (VASRD) guidelines.  The PEB adjudicated “alcohol dependence” and “attention deficit hyperactivity disorder (ADHD)” as Category III conditions (not separately unfit and not compensable/ratable).  The CI made no appeals and after a deduction of 10% for “aggravating factors” 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 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/Naval 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 IPEB – Dated 20051117	VA - (~7 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depression, NOS	9434	10
  -10
0%	Depression and Anxiety	9434	NSC	20060815	
Alcohol Dependence	CAT III Not Ratable	No VA Entry	
Attention Deficit Hyperactivity Disorder	CAT III Not Ratable	No VA Entry	
Other x 0 (Not In Scope)	Other x 2	
Rating:  0%	Rating:  0%	
Derived from VA Rating Decision (VARD) dated 20060926 (most proximate to date of separation [DOS]).
ANALYSIS SUMMARY:

Depressive Disorder, NOS.  The treatment records indicated the CI was diagnosed with ADHD and alcohol abuse in August 2004 that was treated with an anti-depressant medication (bupropion).  Depressive symptoms were present and were attributed to alcohol use.  The CI had reported a childhood history of ADHD.  In October 2004, his primary diagnosis was alcohol dependence, which was treated.  On 11 August 2005, the CI presented to MH due to feeling depressed.  His wife wanted a divorce and a childhood friend had died.  He was doing well prior to the news, but had returned to drinking and had thoughts of suicide around the issue with his wife.  He denied suicidal plans or intent and had also stopped his medication.  He was diagnosed with adjustment disorder.  The CI continued to report depressed mood and anxiety symptoms related to stressors at work and in his marriage.  He noted his relationship with his wife had improved; however, he felt being in the military was a major stressor on his marriage.  Due to the lack of substantial improvement in the CI’s MH, the condition was diagnosed as depression NOS and partner relational problem.  The CI was placed on an S4 profile and referred to the MEB.  On 27 September 2005, the psychiatry narrative summary (NARSUM) noted the CI’s depressive symptoms of depressed mood, hyper-somnolence, low motivation, low energy and lack of pleasure began in January 2004, and were originally considered secondary to his alcohol use.  He was treated with anti-depressant medication with improvement; however, he discontinued the medication in late 2004.  The CI reported he had experienced suicidal thoughts after the news of the death of his childhood friend and wife’s interest in divorce.  In September 2005, his depressive and anxiety symptoms worsened and he felt his functioning had diminished.  At the time of the NARSUM, the CI reported chronic depression with exacerbations and remissions.  Mental status examination (MSE) recorded anxious and depressed mood and affect as the only abnormal finding.  The examiner diagnosed depressive disorder NOS with considerable military duty impairment and mild impairment for civilian social and industrial adaptability.  A Global Assessment of Functioning (GAF) score of 45 (serious) was assessed.  The VA Compensation and Pension mental examination, 7 months after separation, recorded a GAF of 85 (absent or minimal).  The CI was working full-time as a pizza shop manager and had good relationships with his supervisor and co-workers.  He had not lost any time from work.  He had stopped drinking alcohol for a year.  The examiner stated the CI “was not a reliable historian…he exaggerates his symptoms.”  The CI had a girlfriend and reportedly stated his depression was mostly situational due to his poor relationship with his wife.  His MSE was unremarkable and the examiner diagnosed ADHD and noted the CI was not taking psychotropic medication.

The Board directed its attention to the rating recommendation based on the evidence just described.  The PEB’s rating of 10% coded 9434 cited mild social and civilian industrial impairment; 10% was subtracted for “aggravating factors.”  The PEB considered the conditions of alcohol dependence and ADHD as co-morbid contributing factors.  In the absence of each, the condition of depressive disorder NOS would be described as not impairing.  The VA did not service-connect the condition and therefore it was not rated.  The Board first unanimously agreed that VASRD §4.129 was not applicable due to the absence of a highly stressful causative event.  The MEB examination recorded a GAF of 45, which is more commonly associated with a higher than 10% rating under §4.130.  However, the examiner assessed mild interference with social adaptability and civilian industrial adaptability.  The Board noted there were no recorded panic attacks, report of insomnia, suicidal behaviors, psychiatric hospitalizations or legal issues.  The CI had not taken psychotropic medications in the 12 months prior to separation.  Seven months after separation the CI was working full-time, was socializing with his girlfriend and had a GAF of 85.  He was not taking any medication and no longer had the diagnosis of depression.  The 30% description (“occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”) is difficult to support given that the CI reported very few symptoms and presented no evidence of occupational or social impairment at the time of the VA exam.  The 10% description, “occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or; symptoms controlled by continuous medication,” may have reflected the CI’s condition at the time of the NARSUM.  The Board proceeded to discuss the 10% reduction taken by the PEB, and deliberated between the 0% and 10% rating criteria.  The Board considered the PEB adjudication of the level of functioning, absent the alcohol dependence and ADHD disorder, was none and warranted a 0% rating.  The Board reviewed description of criteria under 4.130 for 0% rating, “A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.”  The evidence demonstrated the CI’s psychological symptoms were transient in response to external stressors that led to occupational impairment only during periods of what the CI perceived as significant stress. The treatment records demonstrated a direct relationship between his alcohol use and ADHD and the role each contributed to his depressive condition.  The record demonstrated the CI’s condition remitted in the absence of alcohol, and although he had not taken medication for months, his overall level of functioning did not significantly decrease.  The records reflected consistent improvement in his MH condition that began the month after the NARSUM, and culminated in the complete absence of depressive symptoms 7 months after separation.  The CI at that time had reported a 1-year abstinence.  However, he continued to have inappropriate responses to stressors.  Seven months after separation he no longer experienced depressive symptoms and no longer had the diagnosis.  He was working full-time, had completed two college courses and had a GAF of 85.  All Board members agreed, at the time of separation, the record most accurately reflected the 10% criteria.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the depressive disorder NOS 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 depressive disorder NOS condition, the Board unanimously recommends a disability rating of 10%, coded 9434 IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Depressive Disorder, NOS	9434	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-03381.

	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 assigned disability rating without 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,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachments:
1.  Directive
2.  Record of Proceedings

cc:
SAF/MRBR
DFAS-IN