RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04305
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Automated Logistician, medically separated for “major depressive disorder,” with a disability rating of 10%.

CI CONTENTION:  The CI contends her diagnosis was downgraded from post-traumatic stress disorder (PTSD) to major depression.    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.  

RATING COMPARISON:  

SERVICE PEB - 20050202	VARD - 20060515	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Post-Traumatic Stress Disorder with Major Depression	9411-9434	50%	20060221	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Major Depressive Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI deployed to Iraq from January 2003-July 2003.  She reported being healthy until this deployment when she saw dead bodies in the street, her convoy was ambushed and she feared for her life daily.  The CI accepted a second tour to Korea to help her “get over Iraq.”  However, she felt even more depressed and complained of multiple symptoms including daily lower back pain and headaches, loss of interest, decreased energy, crying spells, poor concentration and impaired memory, interrupted sleep and eating problems.  She had nightmares every night of being chased by the enemy in Iraq and reported panic-like symptoms with a feeling of doom and rapid breathing after a nightmare; she    also had dreams of someone dying.  She admitted suicidal ideation without a plan.  The CI was evaluated in Korea by a psychologist who found profound psychomotor retardation.  Over the previous 5 months, she had felt pervasively sad and hopeless and had flashbacks of being ambushed in a convoy.  Her greatest concern was a quick exit from the Army.  She was treated with anti-depression medication and a sleep aid.  Mental status exam (MSE) noted the CI primarily looked down at the floor, her speech had a monotone quality, and she had a moderate to high degree of psychomotor retardation and constricted affect.  On follow-up she had improved with increased smiling and better sleep.  A diagnosis of major depressive disorder (MDD) was rendered with definite impairment for social and industrial adaptability.  

At the VA Compensation and Pension (C&P) examination on 1 February 2006, performed 11 months after separation, the CI reported her nightmares began after returning from Iraq and became worse in Korea where a psychiatrist diagnosed her with PTSD and returned her to the US for a medical board.  She stated that she lived alone (but had two friends), could not concentrate, was forgetful, and had no motivation.   She was also easy to anger and threw things.  She worked as a technician but had missed 10-13 days in the past 6 months due to fatigue and difficulty getting up.  The VA examiner noted the CI remained in therapy with a social worker and referenced a previous December 2005 psychiatry note indicating that the CI was having nightmares/flashbacks and not sleeping despite medications. She was taking multiple medications for sleep and depression but still having nightly nightmares, panic attacks upon awakening, fatigue, no energy, difficulties with impulse control, and concentration.  MSE revealed constricted affect and test data showed extreme depression.  A diagnosis of PTSD and MDD was rendered with a global assessment of functioning (GAF) score of 50 (moderate symptoms, impairment).  The examiner opined that the PTSD was the primary mental condition with the depression being secondary.  

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).  The VA assigned a 50% rating using the analogous 9411-9434 (PTSD-MDD) code based on the VA C&P examination 11 months after separation, citing occupational and social impairment with reduced reliability and productivity.  The Board first considered if application of VASRD §4.129 with a 6-month constructive period (with a 50% minimum rating) on the TDRL was indicated in this case.  Board members agreed that the provisions of VASRD §4.129 were not applicable due to the absence of corroboration that the CI experienced a highly stressful event severe enough to bring about her release from active military service.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for mental health conditions.  The §4.130 criteria for a 10% rating includes “symptoms controlled by continuous medication” while the 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  Criteria for a 50% rating must indicate “occupational and social impairment with reduced reliability and productivity.”  The CI reported persistent symptoms that included depression, anxiety and sleep problems despite continued therapy and medication management; she was working and did have a few friends.  Board members agreed that she met criteria for a 30% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 30% rating for the MDD condition.

BOARD FINDINGS:  In the matter of the major depressive disorder condition, the Board unanimously recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130.  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 20141119, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160011358,  XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board's recommendation and record of proceedings for your information.

The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.

The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections
have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.   Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretary of the Armv

Enclosure