RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03512
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20080428 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Nuclear Power Technician, medically separated for “major depressive disorder, single episode,” “anxiety disorder not otherwise specified,” “bilateral patellofemoral syndrome,” “dysthymic disorder” and “neurofibromatosis,” with a combined disability rating of 0%.  

CI CONTENTION:  The applicant requests consideration of all conditions in in their application.  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:  

IPEB – Dated 20080314	VA* - ~13 Months  Post-Separation 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder, …Psychotic Features	Overall Effect	0%	No VA Placement	
Anxiety Disorder not Otherwise Specified			No VA Placement	
Bilateral Patellofemoral Syndrome			Chondromalacia, Left Knee	5010-5260	10%	20090605	
			Chondromalacia, Right Knee	5010-5260	10%		
Dysthymic Disorder			No VA Placement	
Neurofibromatosis			No VA Placement	
Intrauterine Pregnancy	Not Unfitting 
Cat III	No VA Placement	
Allergic Rhinitis			
Other x 0 (Not In Scope)	Other x 1	
RATING: 0%	COMBINED RATING:  20%	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Syndrome, MDD, Anxiety NOS, Dysthymia and Neurofibromatosis.  The Medical Evaluation Board (MEB) examiner noted that the CI developed non-traumatic bilateral knee pain in March 2007.  She noted she had pain with ascending and descending stairs, bending, and with prolonged standing.  She was prescribed anti-inflammatory medication and underwent treatment with physical therapy.  The CI was referred to orthopedics and was diagnosed with patellar chondromalacia.  The narrative summary (NARSUM) noted that both knees were ligamentously stable without signs of meniscal pathology, and pain on motion was not elicited.  It was noted that both knees had full range of motion (ROM) to 140 degrees, and sensory and motor function was intact bilaterally.  Radiographs of bilateral knees were unremarkable. 

The VA Compensation and Pension (C&P) was accomplished 14 months after separation.  The examiner noted decreased ROM in both knees, flexion to 125 degrees with pain at the end point.  The examiner opined that it might be estimated that with any strenuous activity such as running or jumping that the range of motion would be reduced to 0-90 degrees in both knees secondary to pain and fatigability.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB bundled the knees with three other conditions for a 0% overall effect rating.  The VA rated the knees separately and assigned an evaluation of 10% each knee based on lack of full flexion (140) and pain on motion.  The Board’s recommendations, IAW DoDI 6040.44, must comport strictly with the VASRD criteria.  Thus conforming to separate ratings, there is no compensable ROM impairment for either knee; and, the evidence does not support the presence of significant ligamental laxity, locking or frequent effusions for either.  There was no treatment entry that considered one knee more impaired than the other.  However, the commander’s statement noted that the CI was not allowed to participate in physical fitness training, and was not considered worldwide assignable.  The condition was profiled. The MEB examiner noted she had minimal improvement with treatment and her ability to run, and squat was limited.  Board members agreed that neither knee was independently unfitting; however, taken together, both interfered with satisfactory duty performance; however, the condition did not rise to the minimal compensable rating.

The Board next reviewed the mental health (MH) conditions.  The NARSUM noted the CI had a pre-service history of depression and anxiety that had caused academic problems in college.  Her depression worsened in October 2006 and again in March 2007.  Her depressive symptoms included irritability, crying spells, fatigue, and insomnia.  She was isolative from others and reported feelings of guilt and decreased self- esteem.  The CI first presented to MH in August 2007.  The examiner noted that she was prescribed medication for depression and anxiety; however, when she became pregnant the antidepressant medication was discontinued.  At her last MH clinic visit December 2007, the CI was experiencing depressed mood, insomnia, and increased appetite.  She had work related stressors, stress from being separated from her husband with the lack of close support by him during the pregnancy, and she had conflicts with her roommate and was mourning the death of her grandfather.  She was also worried about her stepmother’s terminal cancer diagnosis.  The mental status exam was unremarkable with the exception of depressed and blunted affect, opined to have been appropriate to thought content.  The diagnoses of MDD, single episode, moderate, (not EPTS), dysthymic disorder (EPTS, not service aggravated), and anxiety disorder NOS, (EPTS, not service aggravated) were assessed and assigned a Global Assessment of Functioning (GAF) score of 50 (moderate impairment).  The examiner opined that “The total degree of civilian performance impairment from all sources is deemed moderate, but may be mild if her mood lifts with discharge from the Navy and reunification with her husband.”  It was concluded that due to the development of her MDD which was not EPTS, her condition required psychotropic medications and therapy.  The examiner opined that the CI’s condition did not meet retention standards due to MDD.

The Board directed attention to its rating recommendation based on the above evidence.  The NARSUM examiner noted that the CI had moderate symptoms of depression and impairment in global functioning was on the cusp of serious to moderate.  All Board members agreed, the GAF score in this case was lower than what was represented in the treatment record.  Her stressors related primarily to loss of primary support during her pregnancy, grief over loss of one grandparent and the expected loss of the step-mother.  Work stressor was also noted; she had minor difficulty with concentration and made minor errors, and she had interpersonal conflict with her roommate.  It was not clear to what extent, if any, her symptoms interfere with occupational or social functioning. The NARSUM examiner considered the condition of MDD did not meet retention standards; however, the commander’s statement made no mention of a MH condition and no MH condition was profiled.  There was no performance based evidence from the record that any MH condition significantly interfered with satisfactory duty performance.  

The Board noted that the neurofibromatosis condition is a genetic condition which was diagnosed while the CI was in elementary school.  The CI had no complications from this diagnosis, with the exception of the presence of café-au-lait spots, which remained unchanged for years.  All Board members agreed, the preponderance of evidence supported that none of the above noted conditions were independently or separately unfitting; however, there was an overall effect not arising to the level of minimal compensable rating.  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 above conditions.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that intrauterine pregnancy and allergic rhinitis 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.  The contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.    Both were reviewed and considered by the Board.   There was no performance based evidence from the record that either 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 contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the bilateral patellofemoral syndrome, MDD, anxiety NOS, dysthymia and neurofibromatosis conditions and IAW VASRD §4.71a, and §4.130 the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended intrauterine pregnancy and allergic rhinitis 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 20140620, with attachments
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 24 Jun 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 USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- 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 USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC 

						XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						(Manpower & Reserve Affairs)