RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03461
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20060628

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Hospital Corpsman, medically separated for the “overall effect” of four separate mental health conditions, with a disability rating of 0%.

CI CONTENTION:  The applicant requested that all conditions be considered.  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 - 20060308	VARD - 20110727	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	“Overall Effect”	0%	Post Trauma Stress Disorder with Major Depression,
Insomnia, Anxiety and Agoraphobia	9411	100%	20110428	
Panic Disorder with Agoraphobia							
Bereavement			Bereavement	No VA Placement	
Narcissistic and Avoidant Personality Traits			Narcissistic and Avoidant Personality Traits	No VA Placement	
Hypertension	Cat III	Hypertension	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:

Major Depressive Disorder; Panic Disorder with Agoraphobia; Bereavement and Narcissistic and Avoidant Personality Traits.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed symptoms of depression in 1998.  The symptoms were accompanied by marital discord and declining duty performance.  At the time of initial evaluation, there was no history of traumatic stress which may have caused his symptoms and he was diagnosed with major depressive disorder.  At a mental health evaluation in November 2000 the CI reported ongoing anger and dysphoria related to his divorce with insomnia, decreased self-esteem, increase appetite and passive suicidal ideations.  He continued with medication and psychotherapy.  The records evidence one emergency department visit in November 2003 for suicidal ideations related to anxiety over moving to barracks.  At the time he consented to safety and was released.  He continued with medication and psychotherapy until a 1 day psychiatric hospitalization in 2004 for symptoms of panic disorder and suicidal ideations.  Despite treatment with medication and psychotherapy, the CI’s mental health conditions (major depressive disorder panic disorder with agoraphobia, bereavement, and narcissistic and avoidant personality traits) did not improve sufficiently to meet the requirements of the CI’s military specialty and he was referred for MEB.

At the MEB NARSUM examination on 06 January 2006, (4 months prior to separation), the CI reported he was frequent sleep disturbance, increased appetite, decreased enjoyment in otherwise fun activities, frequent depressed and anxious mood, a strongly negative view of himself and the world, and frequent feelings of hopelessness and worthlessness.  He endorsed intermittent thoughts of suicide.  The CI also endorsed discrete panic attack (10-30 minutes of heart racing, shallow breathing, nausea, lightheadedness, and a strong sense of pending doom.  The examiner noted one hospital admission and two partial hospitalizations.  He endorsed transient paranoia.  He denied homicidal ideations.  The mental status examination showed a dysphoric mood, congruent affect, and mild psychomotor agitation.  His speech was normal, thoughts without abnormal content, and judgement and insight were good.  The examiner noted one hospital admission and two partial hospitalizations.  The CI filed his original VA disability claim in 2011, too remote from separation for the Compensation and Pension (C&P) examination to render probative value.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the mental health conditions 0% without a VASRD code, but rather as “overall effect” of the CI’s mental health conditions.  According to DoDI 1332.38, the service presumption in overall effect considers each mental health condition in this case as not separately unfitting and requires a preponderance of evidence to be found unfitting.  Based on the preponderance of evidence, the Board agreed the Axis I major depressive disorder and panic disorder with agoraphobia were unfitting.  Accordingly, based on VASRD §4.130 (mental health ratings) this Board will only render one mental health rating for all of the CI’s PEB adjudicated mental health diagnoses.  The Board first determined that VASRD §4.129 (military separation due to a highly stressful event) was not applicable in this case.  The Board next directed attention to its §4.130 mental health rating recommendation based on the above evidence.

The Board noted the CI received one psychiatric hospitalization and two partial psychiatric hospitalizations for treatment of depression and panic attacks.  He experienced transit paranoia, frequent sleep disturbance, decreased enjoyment in otherwise fun activities, frequent depressed and anxious mood, a strongly negative view of himself and the world, and frequent feelings of hopelessness and worthlessness.  Although the CI was generally functioning satisfactorily, with routine behavior, self-care, and conversation normal, Board members determined that the CI’s chronic and unresolved mental health condition supports a 30% rating for occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks at the time of separation.  The evidence did not support “occupational and social impairment with reduced reliability and productivity (50%);” or “occupational and social impairment with deficiencies in most areas (70%)” for a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the major depressive disorder and panic disorder with agoraphobia conditions, coded 9434-9412.

Contended PEB Condition:  Hypertension.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition did not result in a limited duty status or implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance-based evidence from the record that the contended 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 a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the major depressive disorder and panic disorder with agoraphobia conditions, the Board unanimously recommends a disability rating of 30% coded 9434-9412 IAW VASRD §4.130.  In the matter of the contended hypertension condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Major Depressive Disorder and Panic Disorder with Agoraphobia	9434-9412	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140628, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 22 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 26 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (j) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 0 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     f. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     h. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     i. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	 XXXXXXXXXXXXXXXXXXXX
	 Assistant General Counsel
						   (Manpower & Reserve Affairs)