RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03583
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Mental Health Technician, medically separated for “major depressive disorder,” rated 30%, minus 30% for aggravating factors, for a combined disability rating of 0%.  

CI CONTENTION:  The Ci request consideration of 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 based upon a 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 - 20060329	VARD - 20061010	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	30% minus 30%	Dysthymic Disorder	9433	30%	20060705	
Irritable Bowel Syndrome	7399-7319	Cat II	Irritable Bowel Syndrome	7319	10%	20060720	
Borderline Personality Disorder, Severe	Cat III	No VA Entry	
History of Alcohol Abuse	Cat III	No VA Entry	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Major Depressive Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first treated for depression anxiety and adjustment issues in 1998 with a diagnosis of major depression in December 1999.  The CI was being treated with counseling and multiple different medications until she was hospitalized in July 2003 for major depression with a specific suicide plan, but no actual suicide attempt.  In March 2004 the CI was diagnosed with alcohol dependence and underwent intensive outpatient treatment.  Following completion of alcohol treatment she was followed by psychiatry with diagnoses of major depressive disorder NOS and alcohol dependence in remission with frequent medication adjustments.  In November 2005 the CI was having marital problems and diagnoses were major depressive disorder recurrent and partner relational problems.  Informal depression scale testing was severe.  

At the 9 January 2006 psychiatrists evaluation the diagnoses were major depressive disorder; recurrent, moderate; rule out bipolar disorder, type II; and alcohol dependence, with current use.  The psychiatrist stated “I strongly recommend this service member be removed from her current field of work in the military. She is not mentally qualified to remain a mental health technician or alcohol counselor.  At this point, she remains fit for active duty, and we will continue to attempt to treat her conditions.  However, her fitness may come into question if we cannot improve her mood with aggressive treatment.”  

At the 6 February 2006 psychiatrist evaluation the CI complained of times during the day when she was quite tearful, with dramatic mood swings during the day that caused significant problems with work and her ability to deal with the pending divorce from her husband.  On mental status examination (MSE) her mood was “maybe a little better” and the affect was tearful.  There was no suicidal ideation, delusions, hallucinations or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment, or other abnormality.  The prior rule our bipolar disorder assessment was changed to an Axis II diagnosis of borderline personality disorder.  

The MEB forwarded “depressive disorder NOS, mild;” “borderline personality disorder, severe;” and “problems with primary support group;” for PEB adjudication.  The MEB NARSUM examination on 17 February 2006, 4 months prior to separation, noted the CI was taking medications of Depakote and Cymbalta and did not provide a detailed mental status exam.  The NARSUM indicated that the treating psychiatrist recommended that the CI no longer work in her AFSC and that she was no longer medically qualified to remain a mental health technologist.  The commander’s statement, dated 3 March 2006, noted the CI was not performing her full range of duties especially with world-wide deployable issues.  

The NARSUM psychiatric addendum examination on 17 March 2006, 3 months prior to separation, noted the CI had 8 years of active service and was being referred for administrative separation for an inability to perform her current duty due to a personality disorder.  The CI was followed by the mental health clinic for depressive disorder NOS; alcohol dependence; and borderline personality disorder, had attended alcohol rehabilitation, underwent therapy and was on medications.  There was no mental status examination.  The diagnoses were Axis I:  depressive disorder NOS, mild, with mild civilian impairment and no military impairment; and alcohol dependence in partial remission, with mild civilian impairment and moderate military impairment.  The Axis II diagnosis was borderline personality disorder, severe, with mild civilian impairment and severe military impairment.  Axis IV was problems with primary support group.  The Global Assessment of Functioning (GAF) was 60 (moderate symptom range 60-51).  The examiner indicated that the CI “is being referred for Administrative separation for an inability to perform her current duty due to a personality disorder which thus makes her unsuitable for service.  She does have a depressive disorder however this has not inhibited her ability to perform her job.  She is fit for full duty from a psychiatric standpoint and a medical board is not warranted in her case.”  

At the 5 July 2006 VA Compensation and Pension (C&P) evaluation, performed 1 months after separation, the CI reported being sad, tearful, irritable with occasional insomnia, low energy, poor concentration, difficulty with decisions, and occasional feelings of hopelessness and panic.  Mental status examination there was no recent suicidal ideation, evidence of delusions or hallucinations (or other symptoms suggestive of psychosis), speech disturbance, cognitive impairment or other abnormalities.  Diagnosis was dysthymic disorder with personality traits of bipolar diagnosis.  GAF was 58 (moderate symptom range 60-51).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the major depressive disorder condition at 30% with a 30% deduction for a combined 0%, coded 9434 (major depressive disorder).  The PEB cited definite social and industrial adaptability as evidenced by symptoms, constant medication and hospitalization, but opined that absent the borderline personality disorder (non-ratable/non-compensable) condition, the CI’s social and industrial adaptability impairment would best be described as in remission.  This final rating rationale was most likely IAW DoDI 1332.39 (rescinded).  The VA rated the CI mental health condition at 30% coded 9433 (dysthymic disorder), based on the VA C&P examination 1 month after separation, citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  

Although the CI was diagnosed with major depressive disorder and Axis II borderline personality disorder, a single §4.130 rating is applied based on the overall occupational and social impairment due to the symptoms from all conditions.  The Board noted that there was no traumatic event causing the unfitting mental health condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  The Board next considered the §4.130 rating at the time of separation.  

The Board considered that the CI had a longstanding major depressive disorder diagnosis and treatment with a hospitalization in 2003, treatment for alcohol dependence in 2004 and increased depressive symptoms in 2006 that impaired her duty performance.  The diagnosis of borderline personality disorder was only made in February 2006.  There was no VASRD-complaint mechanism for a reduction from the PEB’s major depressive disorder 30% disability rating for aggravating factors from a personality disorder.  The Board also does not make deductions for alcohol use when as in this case it was attributed to self-treatment of depressive symptoms.  

The Board considered the MEB psychiatrist’s assessment reflecting persisting moderate symptoms and the commander’s March 2006 statement indicating the CI challenges working with difficulty performing full duties, as well as the VA examiner’s assessment of moderate symptoms.  The Board adjudged that the PEB’s 30% rating, prior to their deduction, was in line with the CI’s documented social and occupational impairment and substantiated by the VA examination within 1 month after separation.  All Board members agreed the CI’s condition at the time of separation supported the 30% disability rating, and that her level of impairment was better described as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily).  

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 condition, coded 9434.  

Contended PEB Conditions:  

Irritable Bowel Syndrome.  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 was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, 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.  
Borderline Personality Disorder, Severe; Problems with Primary Support Group; and History of Alcohol Abuse.  Each of these are considered a condition or circumstance not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending any of them as unfitting.  

BOARD FINDINGS:  In the matter of the depressive disorder condition, the Board unanimously recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130.  In the matter of the contended irritable bowel syndrome conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  In the matter of the contended borderline personality disorder, problems with primary support group; and history of alcohol abuse conditions, the Board unanimously recommends no change from the PEB determinations as not compensable or ratable.  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	9434	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140726, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear 

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03583.

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 your separation be re-characterized to reflect disability retirement, rather than 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 determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

Attachment:
Record of Proceedings

cc:
SAF/MRBR 
DFAS-IN