RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03598
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Aviation Operations Specialist, medically separated for “major depressive disorder (MDD) with psychotic features,” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”

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 - 20030401	VARD - 20030721	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD with Psychotic Features	9434	10%	MDD with Psychotic Features	9434	30%	20021209	
Hiatal Hernia 	Not Unfitting	Gastroesophageal Reflux Disease	7399-7346	0%		
Wisdom Teeth Impaction		No VA Placement	
COMBINED RATING:  10%	COMBIEND RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

MDD with Psychotic Features.  The narrative summary (NARSUM), dated 26 and 27 August 2002, was conducted while the CI was hospitalized.  The NARSUM noted the CI was admitted the first time to the hospital in June 2002 after he attended church revival meetings in June 2002.  He had atypical behaviors, which included auditory and visual illusions and/or hallucinations.  He thought the television was speaking to him and that the clothing of staff was sending him special messages.  He also had marked depression with crying spells and suicidal ideation.  He reported an ecstatic or religiously inspired moment of “lost consciousness,” which he thought was a seizure.  A neurological evaluation determined that he had a non-convulsive experience.  A diagnosis of major depression with psychotic features was rendered and he was treated with a medication for psychosis.  Symptoms resolved and he was discharged in early July and did well with mental health follow-up.  He continued to report depressive symptoms and was readmitted 22 August with the same diagnosis.  

There was a recurrence of a delusion and preoccupation with his specific religious orientation.  He had an argument that day with a co-worker with whom he had had previous conflicts.  At admission, he believed the coworker was conspiring against him.  He reported low irritable moods, low frustration tolerance, easy fatigue, worry, low concentration, frequent mood changes and low self-esteem.  He had problems with anger and admitted recent depression related to his religious convictions.  He was responding to a medicine for depression and for psychosis.  A mental status exam (MSE) at admission showed a “nervous and angry” mood.  There was psychomotor agitation.  He was preoccupied with his coworker and suspicious of her.  He denied hallucinations.  He was concerned that he might hurt himself or someone else due to his anger.  At the time of the NARSUM, it was noted that his ability to perform his duties was impaired.  His clinical condition and functional status appeared chronic.  There was some initial reluctance to take the anti-psychosis medication fearing his use of alcohol may have complicated symptoms.  A diagnosis of MDD with psychotic features was rendered with a Global Assessment of Functioning score of 45 (serious symptoms, impairment.)

The commander’s statement, dated September 2002, noted the CI was mentally unstable and unable to do his daily duties.  His duty performance was satisfactory.  His mental impairments prevented him from fulfilling the requirements of his military speciality and prevented the unit from utilizing him in a productive manner.  The commander submitted another statement, on 18 December 2002, which stated the CI had shown tremendous improvement since his last hospitalization and was able to perform all duties to standard and in a proper military manner.  Memorandums were submitted by four co-workers in support of the CI’s appeal to remain active duty military.  The memorandum stated the CI’s disability did not impact the performance of his duties and he was mentally stable and able to perform his daily duties.

At the VA Compensation and Pension (C&P) exam performed 6 months before separation, the CI reported he was sleeping well, his appetite was good, and emotions were stable, as long as he took his medicine.  A nurse practitioner conducted the exam and recorded a normal physical exam with a normal MSE.  A diagnosis of manic depression with psychotic features was rendered.

The Board directed 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 the commander’s second statement, the statements of co-workers, and the CI’s statement to the C&P examiner that he was doing well as long as he took his medication.  Members agreed that his condition was stabilized with continuous medication, thereby meeting criteria for the 10% disability 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 MDD condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that (hiatal hernia, wisdom teeth impaction conditions 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 hiatal hernia, wisdom teeth impaction conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   All were reviewed and considered by the Board.   There was no performance based evidence from the record that any 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 hiatal hernia, wisdom teeth impaction contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hiatal hernia, wisdom teeth impaction conditions, the Board 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 20140708, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for, AR20160008667 (PD201403598)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
I accept the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

Enclosure

CF:
( ) DoD PDBR
( ) DVA