RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00010
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Recruiter, medically separated for “major depressive disorder [MDD], recurrent, post-partum onset,” with a disability rating of 10%.

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 - 20070221	VARD - 20070703	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD, Recurrent, Post-partum Onset	9434	10%	MDD, Not Otherwise Specified (NOS)	9434	30%	20061003	
Bulimia	Cat III	Anorexia/Bulimia	9521-9520	NSC		
New Onset of Hypothyroidism		Hypothyroidism	7903	10%	20060919	
Posttraumatic Stress Disorder		Posttraumatic Stress Disorder	9411	NSC	20061003	
Borderline Personality Disorder	Cat IV	Borderline Personality Disorder	9499-9416	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

MDD, Recurrent, Post-partum Onset.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s MDD condition began in 1995 and was under good control then was exacerbated again in April 2006 during a postpartum period.  The CI’s condition was not able to be improved to the point to allow unrestricted duty and the MEB forwarded “MDD, recurrent, postpartum onset” for PEB adjudication.  The MEB NARSUM examination on 23 January 2007, 4 months prior to separation, noted complaints of depressed mood, feeling worthless, weak, trouble falling asleep, ongoing marital dysfunction, difficulty concentrating and remembering, low self-esteem, and thoughts of escaping her life, but she denied being suicidal.  Mental status examination (MSE) showed agitated and depressed mood, agitated and anxious affect, difficulty standing or sitting still.  Recent memory, immediate recall, and remote memory were all impaired.  The CI was, at times, tangential and circumstantial.  There was no evidence of psychosis.  At the 3 October 2006 psychiatry VA Compensation and Pension (C&P) evaluation, 6 months before separation, the CI reported depressed mood, a feeling of being overwhelmed, inability to sleep because of worry, and frequent crying.  She denied thoughts of self-harm.  MSE showed generally depressed mood, variable affect (cried easily and frequently with moments of bright affect) and no evidence of psychosis.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD condition 10%, coded 9434 (MDD).  The VA rated the MDD condition 30%, coded 9434, based on the VA C&P examination 6 months prior to separation, citing depressed mood, anxiety, feelings of anger and irritability, aggression, low self-esteem, sleep disturbances, poor libido, poor appetite, and thoughts of suicide.  Additionally, the VA cited the STR evidence of recent and remote memory that seemed to be impaired due to the CI’s level of anxiety.  The CI displayed considerable impairment in social and occupational functioning with a long period of inability to perform occupational tasks as evidenced by the commander’s non-medical assessment stating the CI had not been at her assigned station from May to August per doctor’s request.  The evidence also incorporates symptoms of depressed mood, anxiety, chronic sleep impairment and mild memory loss supporting a 30% rating.  The reviewed documents did not contain evidence of flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once per week, difficulty in understanding complex commands, impairment of short and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks), impaired judgment or abstract thinking, disturbances of motivation and mood, or consistent evidence of difficulty in establishing and maintaining effective work and social relationships to support a 50% 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 MDD condition, coded 9434.  

Contended PEB Conditions:  History of Post-Traumatic Stress Disorder (PTSD), history of Bulimia, new onset of Hypothyroidism (currently euthyroid) and Borderline Personality Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  In the case of the history of PTSD, the Board noted a psychology evaluation from April 1996 stating that the PTSD had resolved and there were no subsequent treatment notes for this condition.  Additionally, at the CI’s VA C&P examination, the evaluating psychiatrist found no evidence that PTSD was an active disorder.  With respect to the history of bulimia, the Board noted there were no treatment notes for bulimia during the active service near separation and the VA C&P examination noted the CI had not exhibited this behavior since January 2006 (15 months prior to separation).  Furthermore, 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 contended history of PTSD, history of bulimia, hypothyroidism and borderline personality disorder 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	
MDD, Recurrent, Post-Partum Onset	9434	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141222, 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.

	
	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)