RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03641
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Network Switchboard Operator, medically separated for “major depressive disorder,” with a disability rating of 10%.

CI CONTENTION:  The CI contends 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 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. 

In addition, the Secretary of Defense Mental Health Review Terms of Reference directed a comprehensive review of Service members with certain mental health (MH) conditions referred to a disability evaluation process between 11 September 2001 and 30 April 2012 that were changed or eliminated during that process.  The MH condition was reviewed regarding diagnosis change, fitness determination and rating in accordance with VASRD §4.129 and §4.130.

RATING COMPARISON:  

SERVICE PEB - 20040402	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%		
High Frequency Hearing Loss	Not Unfitting	CI did not consent to the release of VA records	
History of Post-Traumatic Lower Back Pain, Inactive	Not Unfitting		
History of Tension Headaches, Inactive	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  The psychiatric narrative summary (NARSUM) was conducted in March 2005, less than 2 months before separation.  The examiner documented that in September 2003 the CI self-referred to mental health (MH) to be evaluated because he had concern about being bipolar.  He stated that his brother had been diagnosed with bipolar disorder and he was worried.  There was no contact with MH again until 26 November 2003, when he was referred from the medical clinic due to expressing suicidal ideations with a plan of using his gun.  He had recently broken up with his girlfriend but reportedly stated he had gotten over that.   He was admitted to the psychiatry inpatient unit and discharged 9 days later.  Discharge notes recorded diagnoses of mood disorder not otherwise specified (NOS), and adjustment disorder with mixed disturbance of conduct and emotions.  At the time of admission, the CI had symptoms of depressed mood, anxiety and paranoia.  He was managed with an antidepressant medication and medications to treat psychosis and anxiety.  The CI reportedly responded very well to medication and was discharged in stable condition to outpatient follow-up care.  The NARSUM examiner recorded that after his hospitalization, the CI felt that his mood was improving and that he felt that the break-up with his girlfriend was what sent him in a downward spiral.    Since being on medication he reported improvement and stability of symptoms.  His antipsychotic medication was continued due to the intensity of his psychotic symptoms.  At the time of the NARSUM, the examiner indicated his mood was stable and he had not experienced any further psychotic symptoms.  He was taking an antidepressant and an antipsychotic medication.  Mental status examination (MSE) recorded that the CI was fully alert and oriented and he stated his mood was “good.”  His affect was full and appropriate, and there was no evidence of psychosis or of a formal thought disorder.  He denied suicidal and homicidal ideation.  The examiner indicated that his condition had stabilized and had significantly improved; however, given the possibility of recurrence, he was not fit for further military duty.  The diagnosis of MDD, single episode, severe with psychotic features was assessed, and a Global Assessment of Functioning (GAF) score of 65 for mild symptoms and mild impairment was recorded.  Records from the VA were not submitted for review per the CI’s request.

The Board directed attention to its rating recommendation based on the above evidence. The Board first reviewed the records for evidence of inappropriate changes in diagnosis of the mental health condition during processing through the Disability Evaluation System.  The evidence of the available records showed the diagnosis of MDD, single episode with psychotic features was the only diagnosis rendered.  The Board determined that no mental health diagnosis was changed in the disability evaluation process.  This applicant therefore did not appear to meet the inclusion criteria in the Terms of Reference (TOR) of the Mental Health Diagnosis Review Project.  All Board members agreed the diagnosis of MDD with psychotic features was the appropriate diagnosis, and the CI fully met DSM-IV diagnostic criteria.  The PEB assigned a 10% rating under the 9434 code (major depressive disorder) citing single episode, stabilized with a minimum of current symptoms, rated mild.  All Board members agreed that the preponderance of evidence did not support the application of §4.129.  The Board next considered the rating recommendation.  The higher rating of 30% requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” due to  symptoms such as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events.  The NARSUM examiner noted that the CI’s psychotic symptoms had resolved and his mood had stabilized.  At the time of the NARSUM, no current symptoms were recorded.  The examiner noted mild impairment due to his condition. The commander’s statement documented that after hospitalization the CI was able to perform his duty satisfactorily and had met all military standards described on his job description.  It was noted that the CI was working in his primary military specialty prior to his incident and was still performing his duties; however, he was deemed non-deployable.    All Board members agreed, the CI’s condition at the time of separation, most closely reflected the 10% level of impairment for occupational and social impairment due to mild or transient decrease in work efficiency and inability to perform occupational tasks only during periods of significant stress.  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, single episode with psychotic features condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the high frequency hearing loss, history of post-traumatic lower back pain, inactive, and history of tension headaches, inactive 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 high frequency hearing loss, history of post-traumatic lower back pain, inactive, and history of tension headaches, inactive 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, 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the MDD, single episode and IAW VASRD §4.130 the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended high frequency hearing loss, history of post-traumatic lower back pain, inactive, and history of tension headaches, inactive condition, 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 20140801, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160008675 (PD201403641)

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.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA