RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03588
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20080817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E6, Weather Apprentice medically separated for “major depressive disorder,” with a disability rating of 10%.  

CI CONTENTION:  The CI contended that the rating did not reflect the flight commander’s assessment.  He also referenced multiple supporting documents.  The applicant’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 - Dated 20080619	VARD - 20090721  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Depressive Disorder, Not Otherwise Specified	9434	30%	20090707	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  Service treatment records (STR) noted the CI had feelings of sadness, numbness, and detachment in August 2003 during active duty service.  He presented to the emergency room in January 2006 for a crisis evaluation for depression.  He was feeling somewhat homicidal since the holidays and was feeling depressed over possible job future.  He also had suicidal ideation.  He was diagnosed with major depression and treated with a medication for depression.  In July 2006 he received a diagnosis of posttraumatic stress disorder (PTSD) associated with military duties while deployed to Bosnia.  It was later found he did not meet criteria for this diagnosis.  December 2007 he was diagnosed with chronic dysthymia and marijuana abuse, in remission.  One report noted his depression began when he lost a business in 2005 and another report noted he first had depression in his late twenties after a failed relationship.  The commander’s statement noted the CI provided invaluable administrative and staff work, had not missed time from work, and continued to be a productive and valuable member of the unit.  He was working in his primary duty assignment.

The narrative summary (NARSUM), dated August 2007, noted the CI had progressive and worsening depressive symptoms over the past 2 years.  He was referred to the VA for PTSD group therapy.  Consultation with a psychologist noted that the CI would have difficulty if deployed again, noting expected problems with change, transition and social interactions necessary to function effectively.  Diagnoses included PTSD, long term chronic depression and schizoid personality disorder with prominent avoidance traits. 

A psychiatric evaluation from November 2007, noted he was seeking an evaluation to facilitate his retirement from the National Guard.  He reported a history of depression and marijuana use, noting his depression worsened when he stopped the marijuana.  He denied panic attacks and suicidal ideation but thought a lot about conspiracy theories as a coping mechanism.  He was taking a new medication for depression for about 6 months with no apparent benefits.  He had problems with sleepiness.  Mental status examination (MSE) revealed a constricted affect and noted he was socially awkward in the first part of the interview and tended to intellectualize his problems.  A diagnosis of depression was rendered with a Global Assessment of Functioning (GAF) score of 50 (moderate impairment, symptoms.)  The NARSUM Addendum, dated February 2008, noted his medical condition had not changed since the original NARSUM.  The GAF remained 50.

At the VA Compensation and Pension (C&P) examination, dated July 2009, performed 11 months after separation, the CI reported he had been depressed over 20 years.  In addition to occupational struggles, he had problems with relationships and had not had a significant relationship in over 20 years.  He had been married once but never gotten a divorce, and never had sex with his wife, and felt guilty ever since.  He experienced dysphoric mood, low motivation, low energy levels and low self-esteem.  He was currently writing and selling manuscripts for novels.  He had applied for plumbing jobs, had three friends and had a good relationship with his brothers.  He talked to his father once a month.  He read, wrote, walked, bird watched and had a stamp collection.  MSE noted he reported a chronically dysphoric mood and he displayed a wide range of affect.  He denied suicidal ideation.  The examiner noted severe social and emotional impairment due to his depression.  His symptoms appeared related to the symptoms described in August 2003.  A diagnosis of depressive disorder was rendered with a GAF of 50-55. 

The Board directed its attention to its rating recommendation based on the above evidence.  Application of VASRD §4.129 is considered by the Board for all cases of service connected psychiatric conditions resulting in separation; but, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  Under the 9434 code (major depressive disorder), the PEB assigned a 10% rating, and the VA assigned a 30% rating.  

The Board considered if a rating higher than 10% was warranted at the time of separation.  The §4.130 criteria for a 10% rating is “Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.”  A 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.” The Board considered that the NARSUM exam provided scant information regarding his current symptoms and seemed to rely on the consultation visits with the psychologist, the last one occurring in June 2007 and assigning a GAF score of 50.  A NARSUM addendum confirmed the GAF and noted his condition had not changed in the past 6 months.  A psychiatric evaluation conducted 3 months after the NARSUM noted mild psychiatric symptoms, although the GAF was again 50.  The Board noted the basis for the GAF of 50 was not clear and the commander’s statement noted the CI was productive, valued, and was not missing work.  He was working in his primary assignment and did not have duty restrictions.  The C&P examination nearly a year later noted that he was writing and selling manuscripts, had friends, and enjoyed various activities.  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 MDD condition.  

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication.  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 20140731, 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 XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03588.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings