RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03948
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Food Service Specialist, medically separated for “major depression associated with pancreatitis,” with a disability rating of 10%.  

CI CONTENTION:  “VA rating was higher than Air Force.”  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 - 20040326	VARD - 20050308	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depression associated with Pancreatitis	9434	10%	Major Depression Disorder	9434	30%	20050106	
			Chronic Pancreatitis and Residuals	7347	30%	20050106	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:    

Major Depressive Disorder (MDD).  The PEB combined the major depression and pancreatitis conditions as a single unfitting condition coded 9434 (major depressive disorder [MDD]) and rated 10%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for MDD and Pancreatitis conditions are presented separately, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s MDD condition began in 1999 after increased occupational stress.  At the time of initial evaluation, there was no history of traumatic stress which may have caused his symptoms and he was diagnosed with major depressive disorder.  Duty and deployment were restricted and treatment with medication and counselling was initiated.  Follow-up evaluations in 2002 thru 2004 indicated “mixed to poor response to treatment.”  There were no hospitalizations due to MDD or suicidal ideations.  Despite treatment with medication and psychotherapy, the CI’s MDD condition did not improve sufficiently to meet the requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “major depressive disorder” for PEB adjudication.

At the Psychiatry MEB NARSUM examination dated 20 February 2004 (13 months prior to separation) the CI reported worsening depression for nearly 2 years, lack of pleasure, increased guilt, decreased concentration, loss of appetite with a 20-pound weight loss, poor sleep, psychomotor agitation and morning nausea.  The symptoms were accompanied by marital discord leading to divorce and declining duty performance and he presented for care in August 2002.  The psychiatry examination noted that the CI showed a reserved but cooperative attitude, blunted affect, reduced thought product and otherwise normal mental status examination.  The psychiatrist noted “considerable impairment in social and occupational functioning” in his assessment.  In addition, the psychiatrist cited, “the chronic nature of the patient’s current medical conditions limits” the possibility that the prognosis could improve.  At the 6 January 2005 VA Compensation and Pension (C&P) examination (mental health), performed 7 months after separation, the CI reported feeling depressed, hopeless, he isolates at home, he has trouble with his memory and concentration, decreased appetite and insomnia.  Mental status examination showed an odd sense of humor, problems with remote memory and otherwise normal mental status examination.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 9434 code (major depressive disorder), citing definite social and industrial adaptability impairment.  The VA assigned a 30% rating using the 9434 code based on the VA C&P examination 7 months after separation, citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  The CI displayed considerable impairment in social and occupational functioning with intermittent periods of inability to perform occupational tasks resulting in two letters of reprimand for poor job performance and a divorce supporting a 30% rating.  The evidence did not demonstrate difficulty in understanding complex commands, impairment of short and long term memory, impaired judgment, impaired abstract thinking, disturbances of motivation and mood or difficulty in establishing and maintaining effective work and social relationships; therefore, a 60% rating is not supported.  All Board members agreed that the preponderance of evidence did not support the application of §4.129.  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 MDD condition, coded 9434.  

Pancreatitis.  According to STR and the MEB NARSUM, the CI’s pancreatitis condition began in February 2003 without inciting event; however, was attributed to hypertriglyceridemia.  The Gastroenterology MEB NARSUM dated 10 February 2004 (13 months prior to separation) the gastroenterologist (GI) wrote the evaluation from previous notes and does not provide current complaints or an examination.  

At the 29 December 2004 VA C&P examination, performed 7 months after separation, the CI reported that his symptoms began in 2000 and that he had chronic epigastric and right upper quadrant abdominal pain.  CI also reported night sweats associated with chronic pancreatitis.  Physical examination showed mid and epigastric abdominal tenderness, a healing wound and normal amylase and lipase blood tests.  

The Board directed attention to its rating recommendation based on the above evidence.  The Board considered whether the chronic pancreatitis condition, when considered separate from the MDD condition, was unfitting for continued military service.  Board members agreed that the evidence reasonably justified that the functional limitations of the condition contributed to the CI’s inability to perform his military duties and accordingly a separate disability rating is recommended.  The PEB did not assign a separate rating for the chronic pancreatitis condition.  
The VA assigned a 30% rating using the 7347code (Pancreatitis) based on the VA C&P examination 7 months before after separation, citing after partial pancreatectomy a minimum rating of 30%.  There were multiple laboratory tests indicating pancreatitis and the CI had undergone partial pancreatectomy requiring a minimum rating of 30%.  The evidence did not validate loss of normal body weight attributed to pancreatic insufficiency or other findings showing continuing pancreatic insufficiency between acute attacks supporting a 60% rating.  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 chronic pancreatitis condition, coded 7347.  

Contended PEB Conditions: Hypertriglyceridemia, Renal Vein Thrombosis, Hypertension, Seasonal Allergies and S/P Motor Vehicle Accident (MVA) with known Liver and Splenic Lacerations.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the MDD condition, the Board unanimously recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130.  In the matter of the chronic pancreatitis condition, the Board majority recommends a disability rating of 30%, coded 7347 IAW VASRD §4.114.  The single voter for dissent recommended classifying the chronic pancreatitis as not unfitting and did not elect to submit a minority opinion.  In the matter of the contended hypertriglyceridemia, renal vein thrombosis, hypertension, seasonal allergies and s/p MVA with known liver and splenic lacerations condition, the Board unanimously agrees that it cannot recommend them for additional disability rating.  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%	
Pancreatitis	7347	30%	
COMBINED	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140907, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

PDBR PD-2014-03948

MEMORANDUM FOR THE CHIEF OF STAFF

	Having received and considered the recommendation of the Physical Disability Board of Review and under the authority of Title 10, United States Code, Section 1554a (122 Stat. 466) and Title 10, United States Code, Section 1552 (70A Stat. 116) it is directed that:

	The pertinent military records of the Department of the Air Force relating to be corrected to show that:

		a.  The diagnosis in his finding of unfitness was Major Depressive Disorder, VASRD code 9434, rated at 30%; and Pancreatitis, VASRD code 7347, rated at 30%, with a combined disability rating of 50%.

		b.  On 10 June 2004 he elected former spouse Survivor Benefit Plan coverage based on full retired pay, naming as the eligible former spouse beneficiary.

		c.  He was not discharged on 11 June 2004 with entitlement to disability severance pay; rather, on that date he was released from active duty and on 12 June 2004 his name was placed on the Permanent Disability Retired List.