RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03720
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Airman, medically separated for “major depressive disorder,” with a disability rating of 20%.  

CI CONTENTION:  “Please consider 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 - 20050321	VARD - 20060613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	20%	PTSD; Panic Disorder, Major Depressive Disorder…Polysubstance Dependence in Sustained Full Remission	9434-9411	NSC	20051012	
Status Post Overdose	Cat II					
Panic Disorder w/o Agoraphobia						
PTSD	EPTS					
History of Polysubstance Abuse	Cat III					
History of IBS		IBS	7319	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Major Depressive Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health conditions began in childhood.  No issues were reported at accession though and a performance report dated 15 July 2003 showed the she met or was above standards other than for leadership which was not observed.  She was initially evaluated for abdominal pain in 2003, which had been long standing, and was found to be pregnant.  Following delivery, she was evaluated in the primary care clinic on 27 April 2004 and reported abdominal discomfort which began at the age of 15 (6 years earlier).  She was referred to gastro-enterology and a diagnosis of irritable bowel syndrome (IBS) was made and an underlying anxiety disorder noted.  She was then diagnosed with a panic disorder and placed on medications.  A fitness report which closed on 15 July 2004 showed that she met or exceeded standards in all criteria including leadership.  On 10 September 2004, she reported that she had panic attacks since childhood and was then diagnosed with post-traumatic stress disorder (PTSD).  This clinical record is not in evidence.  The CI was placed on limited duty on 29 September 2004.  She continued treatment and duty until 6 February 2005 when she presented to the emergency room for suicidal ideation and was transferred to a local hospital for care after ingestion of medications and alcohol.  She was admitted until 11 February 2005.  She reported depression for 5 months and panic attacks dating to childhood.  This was associated with physical and emotional abuse from her parents and sexual abuse by the son of her babysitter.  She also endorsed abuse from her (separated) husband.  She also reported polysubstance abuse as a teenager including methamphetamine, cannabis, acid, and ecstasy.  The drug abuse, mental health issues, and IBS were all denied on the enlistment history.  She also endorsed a history of bulimia.  She improved over the 5 day hospitalization and was discharged with diagnoses of major depression, single episode, severe and panic disorder without agoraphobia.  The MEB NARSUM was dated 14 February 2005.  It noted the above and the fact that the CI was in an abusive marriage.  She was also under financial stress due to her husband’s behavior.  On examination she had psychomotor slowing and a depressed mood.  She was found to have a major depression, single episode, severe and panic disorder without agoraphobia which did not exist prior to service.  These were thought to impair her return to full duty.  She was also noted to have PTSD which did exist prior to service.  The impairment for duty was thought to be mild and “not unfitting.”  Following discharge from the hospitalization, she continued in a partial hospitalization program beginning on 17 February 2005.  It noted that she had engaged in self-mutilation (cutting herself) since the age of 11 but had not done so for 2 years.  She again reported panic attacks, since second grade, and depression since childhood which worsened in adolescence.  She reported binging and purging (bulimia) since the age of 12.  She again endorsed pre-service drug abuse.  She noted significant problems with her husband.  She was diagnosed with major depression, single episode, severe without psychotic features; panic disorder without agoraphobia; PTSD; and a history of anorexia and bulimia.  Borderline traits were noted under Axis II.  The final fitness report in her record closed on 15 May 2005 showed that she did not meet standards in any criteria, but was progressing.  At the VA PTSD Compensation and Pension (C&P) examination performed on 12 October 2005, 5 months after separation, the CI reported physical and sexual abuse as a child.  She denied mental health treatment prior to service, but reported pre-service panic attacks, binging and purging, polysubstance abuse, and difficulty holding jobs.  She was working in a temporary position and had been employed for 2 months.  She was separated from her husband (who had disappeared) and was the care-giver for her daughter.  She denied military stressors (for the PTSD).  The examiner opined that the depression, panic attacks, and eating disorder were secondary to the (pre-service) traumatic stressors and the PTSD.  A VA outpatient note dated 22 November 2005 noted a normal mood and affect.  A mental health examination on 5 December 2005 for a psychiatric intake (to establish care) was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 30% rating for a major depressive disorder coded 9434 (major depressive disorder) with related Category II conditions of status post overdose and a panic disorder without agoraphobia.  PTSD was also Category I disorder which was a pre-existing condition.  The MEB noted the major depressive disorder condition was aggravated by service but the PEB did not.  A 10% deduction was then made for the existed prior to service (EPTS) component for a combined rating of 20%.  The VA initially determined the mental health conditions were not service-connected and coded them 9434 and 9411 (PTSD).  This was upheld on a review dated 1 May 2007; however, the VA rating decision dated 6 November 2007, rated the PTSD condition at 30% based on a VA FAST letter dated 26 August 1999 which mandated that PTSD be given service-connection if manifested during service even if based on stressors prior to service.  The rating was retroactive to separation since the CI had requested review of the decision within 1 year of the VA adjudication.  The Board first considered the EPTS adjudication by the PEB.  The CI stated in numerous interviews her symptoms were secondary to childhood trauma and both the PEB and VA found the condition to be EPTS.  The CI did not contest the PEB adjudication and reported to the VA examiner that she did not have military stressors for the PTSD condition.  The Board did not find evidence to overturn the PEB adjudication that the mental health conditions were EPTS.  The Board then considered the application of VASRD §4.129 (mental disorders due to traumatic stress).  It noted the MEB NARSUM recorded the PTSD as mildly impairing duty and not unfitting.  The major depressive disorder and panic disorder precluded return to full duty.  The Board also noted the stressful events occurred in childhood prior to service.  Considering all the evidence, the provisions of VASRD §4.129 were not found to be applicable.  The Board then considered the rating at separation.  The PEB and, in a later decision, VA both adjudicated the mental health condition at 30% disabling prior to an EPTS deduction.  The Board noted that the requirements under VASRD §4.130 were met prior to separation as manifested by the hospitalization and partial hospitalization for treatment afterwards.  The records prior to separation show significant difficulties in dealing with her husband.  Following discharge from the service, she and her husband were noted to be separated (he had disappeared).  She was noted to be the caregiver of her daughter and to be working on the VA C&P examination.  Mental health examinations by a psychiatrist 2 months later and 7 months after separation were normal.  Although the record clearly shows the CI was symptomatic prior to accession, there was no evidence in the record to show her actual level of impairment at accession (due at least in part to her failure to disclose her history).  The record also shows her fitness reports in 2003 and 2004 showed that she met or exceeded standards.  The record does not support a deduction for an EPTS condition.  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, without an EPTS deduction.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the IBS and history of polysubstance abuse 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.  Neither condition was profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that these conditions significantly interfered with satisfactory duty performance at separation.  The last clinical visit in the record for the IBS was almost 6 months prior to separation.  At the VA C&P, she denied time lost from work from the IBS in the past year.  The polysubstance abuse was prior to service and not ratable regardless IAW DoDI 1332.39 E.5.1.2.9.1.  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 contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the major depressive disorder, the Board unanimously a disability rating of 30%, coded 9434, IAW VASRD §4.130.  In the matter of the PTSD condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended status post overdose, panic disorder without agoraphobia, history of IBS and polysubstance abuse 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 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 20140811, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 24 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 21 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 21 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 21 Oct 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.  

     b. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 20 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effective date of discharge.  

     d. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.   

     e. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.  

     f. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 0 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.